Question
In looking at the clients medical bills one Chiropractor includes treatments with their office visit or certain treatments will also include other services. For example CMT 1 - 2 will also include heat therapy and electrical stimulation therapy a different Chiropractor bills separately for each service. Why is there such a difference in practice and is one considered the standard way of billing?

Answer
Dear Jane,

Welcome to the most frustrating thing in my practice... billing.  

CMT, or Chiropractic Manipulation Therapy refers to the adjustment only... nothing else.  So if a chiropractor is not billing for electrical stimulation or ultrasound or hot packs, he is providing a valuable service, that is billable, for free.  There are codes for billing for electrical stimulation and heat and ice packs.

Here is the main problem.  Insurance companies make it difficult. We as physicians might believe that a particular therapy would be beneficial for a patient, lets say, like electrical stimulation therapy for reduction of inflammation and pain, But the insurance company might say that they are not going to pay for it.  The doctor/chiropractor, who by nature is a humanitarian, has three choices:

1) I don't do the therapy, and short the patient on his/her needed treatment. The patient then doesn't respond as well to the treatment and becomes frustrated with results.
2) I do the therapy and bill the patient, who I know is unable to pay the extra fees for the needed care. The patient feels cheated because they have to pay more.
3) I do the therapy, which the patient needs but can't afford, and then I take it as a loss, not billing the patient for the balance that is due me. The patient feels better, may or may not be appreciative of the gift that I have given them, and then I, they physician, feel shorted and can't pay my ever increasing overhead.

So, Jane, what is the answer?  Every doctor tries to make the best of choices for their own individual circumstances.  The most "legal" would be #2. Do what is needed, bill for what you did, and let the insurance company and the patient figure out who is going to pay for what.

I hope that this gives you a little insight into some of the current billing issues associated with not only chiropractic, but all medical care.

Keith Biggs, DC
http://www.eastmesachiropractor.com