Current Procedural Terminology (CPT®) coding serves as a means for reliable nationwide communication among physicians and other health care providers, patients, and third-party payors. Because of the importance of CPT coding—and largely because of its impact on reimbursement for services rendered—it is imperative that providers have access to high-quality information about the products and services available regarding proper use of the CPT codes.

The American Chiropractic Association's (ACA) representation and active role in the national coding process gives the association firsthand knowledge and insight to provide the most up-to-date and reliable chiropractic coding information available. This article includes an overview of the CPT coding process and ACA's participation therein. This column also contains an in-depth overview of the chiropractic coding products recommended by ACA. We take pride in developing and suggesting products that will help to ensure proper coding and that will assist doctors of chiropractic in all of their billing needs.

The Creation of a CPT Code

Let's begin by developing a better understanding of the CPT process.

The American Medical Association (AMA) developed and first published CPT in 1966. CPT was intended to encourage use of standard terms in medical records. CPT also helped to communicate accurate information on procedures and services to agencies concerned with insurance claims. Today, in addition to its use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services by most private insurers.

The CPT editorial panel is responsible for maintaining the CPT code set. This panel is authorized to revise, update, or modify the CPT codes. The panel is comprised of 17 members, and of these, 11 are physicians nominated by the National Medical Specialty Societies. The following associations each nominate one member: the Blue Cross and Blue Shield Association, the Health Insurance Association of America, the American Hospital Association, and the Centers for Medicare and Medicaid Services (CMS).

The ChiroCode DeskBook includes information on insurance, diagnoses, procedures, supplies, fees, and compliance.

The co-chair of the Health Care Professionals Advisory Committee (HCPAC), a specialty advisory committee, also serves on the panel. ACA currently has two members who represent doctors of chiropractic in the CPT process. One ACA member is a participant in the CPT HCPAC, and another is a participant in the RVS HCPAC. The RVS HCPAC makes relative value recommendations for CPT codes. Participation in these committees provides chiropractic representation in the CPT process because ACA is represented throughout the development, revision, and valuation process.

Selecting a Coding Manual

The key to fair and appropriate insurance reimbursement lies in accurate procedure coding. Although correct coding is extremely important, it can also be extremely frustrating. As practices expand to include new treatment modalities, the possibility of using the wrong code increases, which is why all chiropractic offices should rely on an accurate and up-to-date coding manual.

Annually, the ACA publishes its Coding Solutions Manual to assist and educate doctors regarding coding and insurance issues. The manual is developed by doctors of chiropractic for doctors of chiropractic, and it is specific to chiropractic coding by detailing codes normally used within the profession. Included in the manual are annually updated CPT, ICD-9, and HCPCS codes, template letters for appealing denials, ACA coding clarifications on hot coding topics, extensive information on evaluation and management coding, CPT modifiers, and clinical examples of how to code properly. In addition, the manual includes information for doctors of chiropractic who are involved in Medicare, Federal Workers Compensation, and the Federal Employee Program.

The AMA also annually publishes new editions of its CPT, ICD-9, and HCPCS manuals. These manuals are intended for all provider types and include all updates to codes for all health care professions. AMA's materials are an excellent resource; however, they are not chiropractic specific.

The ChiroCode institute annually publishes its DeskBook as well. This manual includes information on insurance, diagnoses, procedures, supplies, fees, and compliance.

It may seem unnecessary to purchase a new manual every year, but the changes can be significant, and it is in your best interest to use the most current information available. Many codes are in the book that providers may not be aware of and thus, when only a limited list of codes is available to them, they try to "make the service fit the code." This type of erroneous coding can cause problems if you are ever faced with an audit.

Online Coding Resources

In January 2007, ACA launched an online database of chiropractic coding information. The searchable database allows ACA members to quickly research a database of commonly asked questions, ACA coding clarifications, coding definitions, and template appeal letters. If the answer to a specific question cannot be found in the database, members are prompted to e-mail their query to ACA's Coding and Reimbursement Executive Committee for review. The committee will reply in writing to the inquiring doctor within 10 business days.

The great advantage of this online system is that it offers the most current information available; the database is regularly updated when coding policies are changed, updated, or revised. Access to ACA's database is free for association members.

The shift toward online coding resources is becoming very popular as more providers conduct the business of their practices via the Internet. Similar to ACA, the AMA also has an online coding database available titled The CPT Network.

This database includes code definitions, frequently asked questions, and clinical examples. Access to the database costs subscribers a minimum of $200.

For an additional fee, the AMA also allows subscribers to ask a panel of experts any questions not answered by the CPT Network. AMA no longer accepts coding questions via phone or fax—further evidence of a great shift toward online resources.

Coding Workshops

Coding workshops are among the most popular seminars in chiropractic. Ask your state chiropractic association or local chiropractic college to host an ACA-sponsored workshop in your area.

Proper chiropractic coding is the subject of ACA teleconferences multiple times throughout the year. Teleconferences are 90 minutes in length with 30 minutes allotted for a question-and-answer session. ACA coding teleconferences focus on:

• evaluation and management codes (97201–99205),
• CMT codes (98940–98943),
• modifiers,
• medical necessity,
• bundling and unbundling,
• upcoding and downcoding, and
• coding ethics.

Enrollment fees for participation in ACA teleconferences vary depending on association membership status; reduced rates are available for chiropractic students.

The ChiroCode Institute also hosts chiropractic coding seminars. For a complete list of ChiroCode seminars, visit www.chirocode.com/education.

Talking Points

In an effort to educate providers and insurers, ACA develops talking points and coding policies that address various reimbursement topics, including CPT coding, clinical documentation, Medicare, managed care, and fraud. ACA makes these clarifications and policies available on its Web site (www.acatoday.org), and association staff members often send copies to inquiring doctors.

Regarding CPT coding, the ACA has more than 20 coding clarifications. The newest clarifications released by ACA focus on vertebral axial decompression, infratonic therapy, hydrobed therapy, and proper coding of diagnostic/therapeutic devices. These releases are examples of ACA's efforts to disseminate uniform policy information to all doctors of chiropractic and chiropractic students, as well as payors.

It is important for doctors to understand that while some products on the market will suggest that providers can increase revenue through improved coding, be wary of products that offer too-good-to-be-true results.

Anthony Hamm, DC, FACO, FICC, serves as the chairman of the ACA's Coding & Reimbursement Committee and is the association's delegate to North Carolina. Contact him at .