What’s Your CMT Coding Ratio?

What’s Your CMT Coding Ratio?

Keeping track of your individual code usage is very important for proving compliance, and can really affect your bottom line. The importance of auditing your procedure codes can’t be understated. You may choose to carry out this process on a yearly basis, which is the minimum recommendation. Yet, when it comes to Chiropractic Manipulative Treatment (CMT) codes, since it is one of the most utilized procedure codes by doctors of chiropractic, audit these codes more frequently. There are several guidelines you can follow to see how your ratios compare to other national averages. It’s important to understand that these are guidelines and not recommended ways to fool the insurance companies or increase reimbursements.

Your computer system should provide you with a list of codes and their usage frequency. To gather data from your practice management software, conduct a search for the report that outlines the codes entered for the time period you wish to audit. For example, if you are going to audit the last three months’ usage, on July 1, search for monthly reports from April through June. The report should reflect the total occurrences for each month and code entered in the system. For subsequent audits, you may be able to gather the comparison data for the full period, rather than month-by-month. Check with your practice management software support team if you do not know how to generate this data. If you use the recommendations below, you will be able to see if you are within normal limits of code usage.

The report should look something like this:

CMT Codes:

1. CMT usage across the three spinal codes may vary with your practice style, your adjusting techniques, and other factors. Typically, we’d see from 40%-60% of your codes divided between 98940 and 98941 with a very low percentage showing for 98942 (e.g., you may see 55% – 98940, 40% – 98941, and 5% – 98943; or 35% – 98940, 63% – 98941, and 2% – 98942. These are estimates based on CMS data for relative usage by chiropractors).
2. The total number of 98943 codes should be approximately 25-40% of the number of spinal CMT codes, depending on your likelihood of treating extra spinal regions. The rationale is that an approximate number of patients in a given population will require additional care for extra spinal regions.

Perform these coding audits on a regular basis and record the findings into your Compliance Manual. Be sure that you document areas of concern, create strategies to correct these problems and detail any training that will take place to assist practitioners with needed corrections. This allows you to stay on top of any potential problems associated with over -use of certain codes when coding ratios are out of balance with expected norms.

KMC University is the profession’s expert in third-party payer mechanics. Questions? Contact us today.

Call (855) 832-6562 now or click to schedule a 15-minute Solution Consultation at your convenience.

Solution Consultation