Common Coding Errors in Chiropractic Billing and How to Avoid Them

Written By Bilal Qayyum Butt

Chiropractic billing is a highly specialized field where accuracy in coding is critical. Mistakes in coding not only delay reimbursements but can also lead to claim denials, compliance risks, and lost revenue. In 2026, as the healthcare reimbursement landscape becomes more complex, chiropractic practices must prioritize correct coding and documentation to optimize revenue and maintain compliance. This article explores the most common coding errors in chiropractic billing, their implications, and strategies to avoid them.

1. Understanding the Basics of Chiropractic CPT Codes

The first step to avoiding coding errors is understanding the primary Current Procedural Terminology (CPT) codes used in chiropractic billing. These codes define the services rendered and are critical in determining reimbursement.

  • 98940: Chiropractic manipulative treatment (CMT), spinal, 1–2 regions

  • 98941: CMT, spinal, 3–4 regions

  • 98942: CMT, spinal, 5 regions

  • 98943: CMT, extraspinal (one or more regions, e.g., extremities)

  • 97110: Therapeutic exercises

  • 97140: Manual therapy techniques (per 15 minutes)

  • 97012: Mechanical traction

  • 99202–99205, 99212–99215: Evaluation & Management (E/M) codes for new and established patients

Modifiers such as AT (active treatment), 59 (distinct procedural service), and 25 (significant, separately identifiable E/M service) further clarify the context of services provided. Misusing or omitting these modifiers is a frequent source of coding errors.

2. Common Coding Errors in Chiropractic Billing

a) Incorrect Use of CPT Codes for Spinal Manipulations

Many chiropractors inadvertently bill the wrong spinal manipulation code. For example, billing 98941 (3–4 regions) when only two regions were treated results in overbilling, while underreporting reduces reimbursement. Correct documentation of the number of spinal regions treated is essential.

Tip: Track each region separately in patient charts and cross-reference with the billed CPT code.

b) Failing to Apply the AT Modifier Properly

The AT modifier indicates active/corrective treatment. Medicare mandates its use for spinal manipulation (98940–98942). Claims submitted without it may be denied or considered maintenance care, which is not covered.

Tip: Ensure your billing team checks that every active treatment claim has the AT modifier, and avoid applying it to maintenance or wellness visits.

c) Misuse of E/M Codes with Chiropractic Services

Chiropractors sometimes bill E/M codes (99202–99205 or 99212–99215) alongside manipulative therapy incorrectly. Using modifier 25 is required when an E/M service is significant and separate from chiropractic manipulative treatment on the same day.

Common Mistake: Billing 99213 without modifier 25 on the same day as 98941 may result in denial or downcoding.

Tip: Document evaluation, examination, and medical decision-making separately to justify E/M codes.

d) Improper Use of Manual Therapy Codes (97140)

Manual therapy (97140) is frequently billed incorrectly. Common errors include:

  • Billing 97140 without proper documentation of the time spent or techniques used

  • Billing 97140 on the same body region already billed under 98943 without a 59 modifier

  • Forgetting that some payers require documentation of medical necessity and functional limitation improvement

Tip: Record each manual therapy session with time, region, and objective improvement notes.

e) Incorrect ICD-10 Coding

Coding errors are often rooted in using the wrong ICD-10 diagnosis codes. Using generic codes like M99.00 (segmental dysfunction of the spine) without specifying the region can trigger denials or payer inquiries.

Tip: Use precise codes aligned with documentation, such as M99.03 for thoracic segmental dysfunction, ensuring every CPT code has a corresponding ICD-10 code.

f) Double Billing or Overlapping Services

Billing multiple services for the same treatment session without proper modifiers leads to overpayment accusations and claim rejections. For instance, billing 98943 (extraspinal) and 97140 (manual therapy) on the same region without a 59 modifier can trigger denial.

Tip: Maintain clear documentation of body regions, procedures, and time spent per service to avoid overlap.

g) Inadequate Documentation

Inadequate or vague documentation is a leading cause of claim denials. Examples include:

  • Failing to note the exact spinal regions treated

  • Not recording patient progress or functional improvement

  • Lack of clear treatment plans for continued care

Tip: Train providers to maintain detailed charts including the start and end of treatment, spinal regions, techniques used, and clinical outcomes.

h) Billing Non-Covered Services

Some chiropractic services, like wellness visits or maintenance therapy, are not reimbursable by Medicare or certain commercial payers. Billing these services incorrectly results in denied claims.

Tip: Identify covered versus non-covered services and communicate clearly with patients regarding out-of-pocket charges.

3. Consequences of Coding Errors

Coding errors in chiropractic billing can have several negative outcomes:

  • Delayed Reimbursement: Claims denied or underpaid prolong cash flow cycles.

  • Lost Revenue: Incorrectly coded services may never be reimbursed.

  • Compliance Risks: Persistent errors increase the likelihood of audits and potential penalties.

  • Patient Dissatisfaction: Billing mistakes can lead to disputes and complaints, affecting patient retention.

Avoiding coding errors is therefore essential for maintaining both financial stability and regulatory compliance.

4. Strategies to Avoid Common Coding Errors

a) Implement a Standardized Coding Protocol

Establish clear internal guidelines on CPT and ICD-10 code selection. Provide staff with coding manuals and cheat sheets for quick reference.

  • Include common scenarios for spinal manipulations

  • Define rules for using modifiers (AT, 59, 25)

  • Document how manual therapy and E/M codes should be billed alongside manipulative treatments

b) Regular Staff Training

Billing staff and providers should undergo quarterly training sessions covering:

  • CPT/ICD-10 updates

  • Documentation requirements

  • Payer-specific guidelines

  • Use of electronic billing software

Tip: Include case studies of common mistakes and how to correct them.

c) Conduct Internal Audits

Regular internal audits of claims help identify recurring errors and educate staff to prevent future mistakes.

  • Sample 10–15% of claims monthly

  • Check CPT/ICD accuracy, modifier usage, and documentation completeness

  • Track patterns and implement corrective action plans

d) Leverage Technology and Billing Software

Modern chiropractic billing software can flag errors before claims are submitted:

  • Automated coding verification

  • Modifier alerts

  • ICD-10 cross-checks

  • Claim status tracking

Tip: Integrate software with your EHR system for real-time coding feedback.

e) Partner with a Specialized Chiropractic Billing Company

Outsourcing to experts ensures claims are coded correctly and submitted efficiently. A specialized billing partner like ChiroBillNC can:

  • Provide end-to-end revenue cycle management

  • Ensure CPT and ICD-10 codes match documentation

  • Manage denials and appeals

  • Optimize reimbursement rates

  • Keep your practice compliant with payer regulations

This allows your practice to focus on patient care while ensuring accurate, timely billing.

f) Maintain Clear Communication Between Providers and Billing Staff

Miscommunication is a common source of errors. Providers should clearly document services, regions treated, and time spent, while billing staff must interpret charts accurately and apply the correct codes and modifiers.

Tip: Schedule weekly or bi-weekly meetings to review complex cases and coding updates.

g) Stay Updated on Payer Guidelines

Insurance carriers frequently update rules for reimbursable services. Billing errors often occur when staff rely on outdated information.

  • Review commercial payer bulletins regularly

  • Update internal billing guides when new CPT or ICD-10 codes are released

  • Educate staff about changes to coverage, modifiers, and documentation requirements

5. Best Practices to Minimize Errors

  • Double-check claims before submission for CPT/ICD-10 and modifiers

  • Use a standardized billing workflow to ensure all checks are applied consistently

  • Document thoroughly: progress notes, objective findings, treatment plans

  • Audit periodically to catch trends and correct them

  • Leverage technology for coding assistance

  • Outsource to specialists for complex claims or multi-location practices

6. Key Takeaways

Correct chiropractic coding is essential to maximize revenue, ensure compliance, and maintain patient satisfaction. Common errors like misused CPT codes, missing modifiers, inadequate documentation, or incorrect ICD-10 coding can significantly impact a practice’s bottom line.

Avoiding errors requires:

  • Mastery of CPT, ICD-10, and modifiers

  • Thorough and accurate documentation

  • Internal audits and staff training

  • Leveraging technology for automated checks

  • Partnering with specialized chiropractic billing experts

By proactively addressing these areas, chiropractic practices can minimize denials, improve reimbursement rates, and operate efficiently in 2026 and beyond.

Conclusion

Chiropractic billing errors are costly but preventable. With attention to detail, ongoing staff education, proper documentation, and the right billing partner, practices can reduce errors, speed up reimbursements, and ensure compliance. Partnering with a company like ChiroBillNC, which specializes in chiropractic billing and revenue cycle management, offers an added advantage for practices seeking higher accuracy and faster payments.

Prioritizing coding accuracy now will safeguard revenue, enhance patient trust, and position chiropractic practices for long-term success in a competitive healthcare landscape.

Bilal Qayyum Butt
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