Documenting Medicare for Chiropractors

What are the essential elements?

For Medicare the chiropractor needs:

  • At least partial completion of the ‘P.A.R.T. system’ for each area billed
  • A diagnostic for each body area that you will bill 
  • A Functional assessment and goals

Let’s define what the P.A.R.T. system is:

P stands for Pain
A stands for Asymmetries
R stands for Range of motion
T stands for Tissue, Tone changes

At least 2 of the 4 P.A.R.T.'s components must be met, with at least one of them being the “A” or “R” component.

DocuRehab’s public charting has all the P.A.R.T. system criteria and is always available to the DC online wherever they may need them.

*Functional assessment can be filled out by the patient directly through the patient portal in the comfort of their home.

How does Medicare Billing Work for the Chiropractor?

Medicare only reimburses for the following limited codes:
98940 1 to 2 areas
98941 3 to 4 areas
98942 5 areas

98943 for extremities

Each treated area must carry a diagnostic code and justification for that diagnostic code. The difference in payment to the practitioner between 98940 and 98941 on average is around the five dollar range. Medicare’s payments are structured so the more body areas the chiropractor treats, the higher the code assigned and more monies received for treatment.

Sadly it is known through late Medicare reviews that many practitioners assign the higher codes without the justification (most likely attempting to skim a bit of extra money from what starts at a very low payment.)

It is worth noting when a chiropractic practitioner uses a higher code it forces much more extensive documentation required to Medicare while the payout remains small and the chiropractor runs a higher risk audit.

Is it worth the monies and legal risk?

Are Medicare payouts worth the time they require in the additional documentation? In a clinical sense greater documentation is always a positive but in the economic arena it is certainly not a great investment of time for the chiropractic profession.

DocuRehab and its “print what you select” charting eases burden on the chiropractor by recording for print only the elements selected. Allowing the chiropractor to speed through the required documentation and eliminating much of the additional work. It also offers the flexibility to document several body areas fast and efficiently.

Medicare billing for the physical therapist:

Medicare gives reimbursement and payment to the physical therapist on many more codes but using several body areas does increase the payments. The PTs’ documentation addresses a limited number of body areas but results in a higher payout while requiring much less documentation.

DocuRehab software and its “module base charting” enable the therapist to assess extensively each body area treated by calling more questions as they are required during an initial evaluation and eliminating them in a swipe from a regular visit. This saves tremendous time while enhancing clinical documentation.

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