Honest conversations about coding

We need to start having more honest conversations about coding, documentation, audits, and the fear many providers carry around reimbursement.

We can talk about UNDERCODING and downcoding by chiropractors who fear audits, most often unjustly, while carriers send automated letters claiming providers “overutilize” certain codes based solely on algorithms, without reviewing a single patient note.

The reality is this:

Most chiropractic coding errors are not fraud by intent.

They are documentation failures, systems failures, workflow failures, and education gaps.

Some reviewers only see the worst of the worst cases.

That is not the average chiropractor I speak.

One of the most common problems I see?

Billing higher-region CMT codes without documentation that clearly supports the regions treated.

Example:

• Billing 98941 or 98942

• But SOAP notes only document 1–2 spinal regions clearly

This creates:

❌ Denials

❌ Downcoding

❌ Audit exposure

❌ Delayed reimbursement

The solution is not simply “better billing software.”

The solution is stronger clinical documentation tied directly to:

• Objective findings

• Medical necessity

• Region specificity

• Functional outcomes

• Accurate ICD-10 linkage

Another major issue?

Incorrect modifier usage.

Examples include:

• Forgetting the AT modifier on Medicare active treatment claims

• Using modifier 25 routinely without a truly separate E/M service

• Billing therapies without timed documentation

Coding should clearly tell the story of the patient encounter so another provider — or auditor — can understand:

“What was wrong, what was treated, why it was medically necessary, and what changed?”

The practices with the least billing stress usually have:

✔ Consistent systems

✔ Clean documentation habits

✔ Outcome-focused care plans

✔ Staff education

✔ Regular chart audits

Documentation is not separate from patient care.

It IS part of patient care.

But compliant documentation does not need to be overly complex.

When coding, diagnosis, documentation, and outcomes align, practices grow with far less friction.

Are you ready to rethink your systems?

Are you ready to engage in conversations that focus on concepts, not just protocols? We will focus education coming up on what you can do in your practice to create a better concept.

Hope you will come along for the ride; we have to change in order for our business to grow and change. More to come, STAY TUNED!