E/M Services, Modifier 25, and Chiropractic: Tips for Documenting, Coding, Billing, and Appealing Inappropriate Denials

Recorded On: 01/27/2024

Modifier 25 denials are on the rise by multiple payers across the country. Attendees will discuss clinical practice guidelines for periodic patient assessments throughout a chiropractic treatment plan. With these clinical concepts as a foundation, participants will delve into key concepts related to modifier 25 and bundling rules that apply to Evaluation and Management (E/M) services performed on the same date as other chiropractic procedures. The session will conclude with a discussion of the practical applications of these concepts to chiropractic documentation, coding, billing, and appeals for inappropriate modifier 25 denials of E/M services.

Upon completion of this presentation, learners should be able to:

Examine clinical guidelines related to patient assessment throughout a chiropractic treatment plan.
Compare and contrast AMA CPT® bundling rules and National Correct Coding Initiative (NCCI) bundling rules related to modifier 25 in the chiropractic setting.
Discuss how modifier 25 concepts apply to chiropractic documentation, coding, and billing practices.
Learn strategies to appeal inappropriate modifier 25 denials by third-party payers.

2 CE Credits

PACE ID: 0127244

T. Matthew Christopher, DC, MBA, CPC, CPMA, CPCO, CPB, CCPC

T. Matthew Christopher is a chiropractor, peer reviewer, and Certified Professional Coder (CPC) with an MBA in Healthcare Administration and additional compliance, billing, and specialty coding certifications. Matthew and his wife Elizabeth, also a chiropractor, reside in Kentucky with their two children, Ian and Liza.

Dr. Christopher is a licensed chiropractor in Kentucky and South Carolina with extensive experience performing chiropractic peer reviews. For more than ten years, he has also provided education on medical necessity and coding for conservative musculoskeletal treatments to groups of providers, coders, expert witnesses, attorneys, law enforcement officials, and insurance industry special investigators. He has coauthored insurance industry clinical practice guidelines and coding guidance for state and national professional associations.

 Dr. Christopher is a member of the Peer Review Committee of the Kentucky Board of Chiropractic Examiners and the Health Policy and Advocacy Committee of the American Chiropractic Association. Additionally, he has held multiple executive board positions within the Council on Forensic Sciences of the American Chiropractic Association and served on the Insurance Relations Committee of the Kentucky Association of Chiropractors.