Work-related musculoskeletal injuries treated by chiropractors can be reimbursed through medical billing if the chiropractor submits accurate claims to insurance companies with proper documentation of the injury. Accurate diagnosis and use of valid ICD-10 and CPT codes are critical for reimbursement, as they provide information about the patient's condition and treatment. Medical billing specialists can help chiropractors with the documentation, coding, and billing processes to facilitate reimbursement and comply with insurance requirements.

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Documenting Work-related Injuries in
Chiropractic Medical Billing
Workplace musculoskeletal injuries treated by a chiropractor can be
reimbursed by submitting accurate medical claims to insurance
companies.

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Workers are often exposed to different health hazards. Chiropractic care is considered a
good option for work-related musculoskeletal conditions including back pain, carpal tunnel
syndrome, headache and neck pain. According to a report published by the University of
Maryland, more than one million back injuries are sustained in the workplace every year
and these injuries account for one in every five injuries and illnesses at the workplace.
Chiropractors or chiropractic physicians – practice a hands-on, drug-free approach to health
care that includes patient examination, accurate diagnosis and treatment. Proper
documentation is critical for the success of chiropractic medical billing.
Clinical documentation is used by claims adjusters and insurance providers to determine the
extent of medical coverage. Failure to adequately document an injury can severely limit a
worker's legitimate access to care. Documentation must include a list of potential injuries
and sources of pain, and detailed physical examination findings.
In addition, accurate documentation can help control the rising workers' compensation costs
by better conveying how an injury is related to work.
Accurate Diagnosis Crucial for Better Reimbursement
Accurate diagnosis is critical to identify the exact condition of the patient and provide
appropriate treatment. Chiropractors assess patients through clinical examination,
laboratory testing, diagnostic imaging and other diagnostic interventions to determine when
chiropractic treatment is appropriate, and when it is not appropriate. The physician’s
diagnosis represents the patient's condition to the insurance company and must be very
accurate.
For chiropractic services to be considered reimbursable, insurance companies are requiring
that the diagnoses are valid and compatible with the CPT (procedure) codes, and
substantiated by the physician’s documentation. Never assume the condition without a
diagnostic test. However, payment for chiropractic services is limited to treatment
consisting of manual manipulation of the spine to correct a subluxation as demonstrated by
x-ray to exist. Worker’s compensation usually fully covers employees’ chiropractic care if
they experience an accident while on the job.
Medical billing specialists use valid ICD-10 codes that facilitate authorization, claim
payments and support the medical necessity of the service in case of review, audits or
litigation. Codes must support neuromusculoskeletal (NMS) conditions, and represent the
body regions requiring treatment.

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Here is a list of some ICD-10 codes applicable for the chiropractic specialty.
 G56.03 Carpal tunnel syndrome, bilateral upper limbs
 M25.50 Pain in unspecified joint (Sacroiliac joint)
 M54.5 Low back pain
 M54.12 Radiculopathy, cervical region
 M54.31 Sciatica, right side
 M54.32 Sciatica, left side
 M62.81 Muscle weakness (generalized)
 M62.830 Muscle spasm of back
 M75.01 Adhesive capsulitis of right shoulder
 M75.02 Adhesive capsulitis of left shoulder
 S76.011A Strain of muscle, fascia and tendon of right hip, initial encounter
 S76.012A Strain of muscle, fascia and tendon of left hip, initial encounter
 S13.4XXA Sprain of ligaments of cervical spine, initial encounter
 S39.012A Strain of muscle, fascia and tendon of lower back
 W10.0XXA Fall (on)(from) escalator, initial encounter
CPT Codes for Chiropractic Treatments
CPT codes communicate uniform information about medical services and procedures to
healthcare payers. These codes can be used to represent the various levels of chiropractic
manipulative treatment.
Spinal manipulation services are covered under the following CPT codes:
 98940 (manipulation to one to two regions of the spine)
 98941 (manipulation to three to four regions of the spine)
 98942 (manipulation to five regions of the spine)
 98943 Extraspinal, 1 or more regions
Each year CPT codes usually undergo certain revisions, updates and deletions. Chiropractors
should be aware of these coding changes for an accurate medical billing and coding process.
Professional physician billing services are now available to help chiropractors report the
new codes, reduce error rates, achieve compliance and maximize revenue.