This is a reminder regarding
the reporting of Evaluation & Management (E&M) services along with
spinal/extraspinal manipulation codes. The chiropractic manipulation treatment
codes include a pre-manipulation patient assessment. Therefore, E&M
services are not eligible for separate reimbursement when provided in
conjunction with chiropractic spinal manipulation, with the following
exceptions:
- when the initial E&M is
for a new patient. A new patient is one who has not received any professional
services from the physician, or another physician of the same specialty who
belongs to the same group practice, within the past three years.
- when the E&M service is
provided for an established patient with an acute exacerbation of symptoms or a
significant change in condition, or the E&M service is performed for a
condition distinct from that of the chiropractic spinal manipulation. Providers
should append modifier -25 (significant, separately identifiable E&M
service by the same physician on the same day of the procedure or other
service) to the appropriate E&M procedure code to indicate that a separate
service has been performed.
When E&M services are provided, the
level of the E&M reported must reflect the appropriate level of service
performed and must be documented in the individual?s medical record. Routine
use of E&M services without justification and reporting E&M services
when other services are being performed is not an appropriate billing practice
and is subject to post-payment review.
For additional information on the
appropriate reporting of modifier -25 with an E&M code and the reporting of
spinal/extraspinal manipulation codes with E&M, see Claim Payment Policy
#03.00.06h (Modifier 25: Significant, Separately Identifiable Evaluation and
Management Service by the Same Physician on the Day of a Procedure or Other
Service) and Medical Policy #10.02.02e (Chiropractic Spinal and Extraspinal
Manipulation Therapy). These policies are available on our website at www.amerihealth.com/medpolicy.