How CPT Code 98943 Can Enhance Your Chiropractic Billing Efficiency

Chiropractic billing can be complex, especially when dealing with several CPT codes to ensure accurate reimbursement for services provided. CPT 98943 plays an important role in documentation and billing for additional spinal cerotic manipulations among these codes.

Understanding and implementing this code correctly can improve billing efficiency and customized revenue. In this article, we will break the CPT code 98943, explain its proper use, discuss general challenges, and provide you with suggestions to help avoid billing errors.

What is CPT Code 98943?

CPT 98943 is used for additional spinal areas such as hands, legs, shoulders, legs, or other loops for chiropractic manipulation treatment (CMT). While spinal adjustment is a primary focus of cerotic care, it is also necessary for many patients experiencing combined pain or mobility issues.

Billing appropriately for these treatments ensures that chiropractors are greatly compensated for their extensive care. According to the official guidelines, CPT 98943 includes one or more additional spinal cord regions, including: including:

Upper and lower extremities (arms, hands, legs, feet)

Rib cage (excluding cost transverse and cost vertebral joints)
Jaw (TMJ), shoulder, hip, or other non-spinal areas

Using this code correctly allows chiropractors to reflect the full range of treatments provided, preventing lost revenue due to underbilling.

When to Use CPT Code 98943?

Chiropractors CPT 98943 should be used when manual manipulation treatment in extreme or additional spinal cord areas. This code is often used with the Spinal Adjustment Code (CPT 98940-98942) to cover the full scope of chiropractic care during the patient’s visit. Some common landscapes where CPT 98943 applies, include:

Treating knee or ankle pain along with a lumbar spine adjustment
Adjusting a patient’s shoulder while also treating back discomfort
Addressing TMJ dysfunction in conjunction with cervical spine manipulation

Since Medicare does not cover extra spinal manipulations under CPT 98943, it’s essential to verify insurance policies before billing to avoid denials or reimbursement issues.

Challenges in Using CPT 98943 for Chiropractic Billing

While CPT 98943 helps chiropractors bill accurately for extra spinal treatments, it also comes with some common challenges:

Underutilization – Many chiropractors fail to use this code or incorrectly bundle it with spinal adjustments, leading to missed revenue.
Insurance Variability – Not all insurance providers reimburse for extra spinal manipulations, and some require prior authorization.
Documentation Requirements – Incomplete records can result in claim denials, audits, or payment delays.
Modifier Usage – Failing to use appropriate modifiers can lead to rejected claims when billing CPT 98943 alongside spinal adjustments.
Denied Claims – Without proper code pairing or sufficient medical necessity documentation, claims for CPT 98943 can be denied, affecting cash flow and practice revenue.

How to Ensure Proper Documentation for CPT 98943

Accurate documentation is key to securing reimbursement and preventing claim denials. Chiropractors should ensure that patient records outline:

Medical Necessity – Justify why an extra spinal adjustment was needed based on symptoms, diagnosis, and treatment plan.
Treatment Details – Specify which extremity or non-spinal area was treated, including the technique used.
Patient Progress – Show how the treatment fits into the patient’s overall care plan.
Separation from Spinal Adjustments – Differentiate between spinal and extra-spinal treatments in your documentation.

Key Billing Tips for CPT Code 98943

To maximize reimbursement and avoid common billing errors, follow these best practices:

Verifies Insurance Coverage – Check payer policies to confirm whether they cover extra spinal manipulations and whether prior authorization is required.
Use Proper Modifiers – When billing CPT 98943 with spinal adjustments (CPT 98940-98942), use modifier 59 to indicate separate medical services.
Pair Codes Correctly – Ensure that CPT 98943 is properly paired with relevant spinal adjustment codes when both treatments are performed in the same session.
Avoid Overbilling – Only bill CPT 98943 when extra spinal treatment is medically necessary, rather than routinely applying the code.
Educate Patients – Help patients understand why they are being billed for extra spinal adjustments, reducing confusion and payment delays.

Common Mistakes to Avoid When Using CPT 98943

Incomplete Documentation – Failing to document the necessity and details of the treatment can lead to denials.
Incorrect Code Pairing – Billing CPT 98943 with incompatible codes can trigger claim rejections.
Assuming All Insurers Cover 98943 – Always check with individual insurance providers to determine coverage policies.
Lack of Prior Authorization – Some insurers require pre-approval before covering extra spinal manipulations, so confirm this before treatment.

Conclusion

Chiropractic billing efficiency is necessary to maintain financially stable exercises. CPT 98943 allows chiropractors to accurately bill to add extreme, which ensures proper reimbursement for the entire range of remedies provided. By understanding this code, implementing the correct modifier, and keeping full documentation, chiropractors can prevent billing errors, reduce claim refusal, and adapt revenue.

The CPT 98943 is an essential step towards improving the financial health of your practice, ensuring compliance with the payment guidelines. Being informed and active, you can streamline your billing processes, increase cash flow, and continue to provide high-quality patient care without administrative failures.

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