Coding & Documentation

Coding Comments & Advocacy

ACA advocates on behalf of the chiropractic profession for fair coding and documentation policies. Read recent correspondence to insurers and regulators below:

ACA Signs Letter to Cigna Regarding Modifier 25 Policy (April 2023)*
ACA and more than 100 healthcare groups united to oppose a Cigna policy requiring submission of office notes with all claims.
Letter to Cigna Regarding Modifier 25 Policy (PDF)

  • Update (May 2023): ACA has received word that Cigna is postponing implementation of the new policy that would have required providers to submit office notes with all claims. More updates will be posted as information becomes available. 

ACA Signs Support Letter for PPI Survey (April 2023)
ACA and more than 170 healthcare groups united in support of a study of physician practices designed to collect information for decision-makers and payers that will help them better understand the broad clinical, operational, and financial challenges that modern practices face.
Support Letter for PPI Survey (PDF)

Coding

Coding, documentation, and reimbursement aids are made available under the direction the ACA Coding Advisory Board and representatives to the AMA CPT® and RUC coding process.

ACA Members Only

About ICD-10

ICD-10 is the tenth edition of the International Classification of Diseases. ICD-10 is an internationally recognized medical coding system primarily designed by the World Health Organization (WHO). It lists health conditions by categories of similar diseases and further delineates more specific conditions under these, thus mapping nuanced diseases to broader morbidities. Learn more about ICD-10 by clicking here.

Verification of Benefits

A proper verification of benefits is an essential step in billing insurance.  It provides the foundation for proper coding and billing, as well as appealing denied claims when it becomes necessary.  Learn ACA’s Clinic Management Series takes participants through the steps of verifying benefits, giving examples of  what to look for and the questions to ask, and highlighting specific scenarios, including instances when special questioning may be necessary. This course is intended for anyone whose work focuses on clinical administration: CAs, claims billers and coders, office managers, and doctors.

The Clinic Management Learning Series Includes:

  • Verification of Benefits: Understand the necessary components of a properly executed verification of benefits and know instances when certain special questioning is needed.
  • Appeals: Understand the importance of appeals (including ERISA) and the basic process and follow through needed for optimum chances of overturning a denial.
  • Self-Audits: Be able to apply the information provided in order to help ensure necessary components of medical records are in place and self-audits are performed.
  • HIPAA: Be able to identify whether their clinic is in compliance with HIPAA’s basic changes and will understand both consequences of a breach and notification requirements.
  • Provider contracts: Be equipped to confidently review and understand essential portions of provider contracts and what questions to ask of payers.

 

 

Anti-Trust and Fees

ACA often receives concerns from providers regarding reduced fees or fee schedule changes implemented by insurers. ACA is a nonprofit professional association and vigilantly follows anti-trust regulations, which forbid discussion or organization about fees and pricing information between providers and other groups. ACA is prohibited, by anti-trust laws, from gathering or disseminating any current data that would indicate an appropriate dollar figure for any given treatment or procedure.

In addition, ACA is prohibited from permitting discussion of any term, condition or requirement upon which any chiropractor deals or is willing to deal, with any payor; or any intention or decision with respect to entering into, refusing to enter into, threatening to refuse to enter into, participating in, threatening to withdraw from, or withdrawing from any existing or proposed participating agreement with any third-party payor or vendor.