Common Coding Errors in Chiropractic Billing and How to Avoid Them | 2026 Chiropractic Billing Guide

Chiropractic practices rely heavily on accurate billing and coding to maintain financial stability, reduce denials, and improve reimbursement rates. Yet chiropractic services face some of the highest denial rates across outpatient specialties, primarily due to coding errors, insufficient documentation, and payer-specific compliance rules.

The challenge is not just accuracy. It is understanding nuance. Chiropractic coding involves strict Medicare guidelines, specific CPT codes, medical necessity requirements, and clear distinctions between active treatment and maintenance care. Even small mistakes may cause claim rejections, audits, delayed payments, or reduced reimbursements.

This guide outlines the most common chiropractic coding errors and provides actionable strategies to help your practice stay compliant, protect revenue, and improve billing efficiency.

Why Coding Errors Are Common in Chiropractic Billing

Chiropractic billing is complex because:

• Payers have different rules for spinal manipulation services.

• Medicare allows only 98940–98942 for chiropractic manipulation and denies most adjunct services.

• Documentation must prove medical necessity and functional improvement.

• Providers must differentiate between active care and maintenance care.

• Modifier misuse is common.

• Many practices lack specialized chiropractic billing expertise.

Understanding the common errors is the first step to preventing them.

Error 1: Incorrect Use of CPT Codes for Spinal Manipulation (98940, 98941, 98942)

The most frequent error in chiropractic billing is inaccurate use of spinal manipulation codes.

Overview of CPT Codes:

• 98940: Treatment of 1–2 spinal regions

• 98941: Treatment of 3–4 spinal regions

• 98942: Treatment of 5 spinal regions

Common Issues:

• Coding 98941 or 98942 when documentation shows fewer regions were treated.

• Using symptoms rather than adjusted regions to determine the code.

• Documentation inconsistencies due to copy-paste templates.

• Overcoding based on assumptions rather than actual treatment.

How to Avoid This Error:

• Document the exact regions adjusted.

• Ensure daily notes match the CPT code billed.

• Conduct routine chart audits.

• Use EHR alerts or checklists to verify the number of regions treated.

Correct region-based coding reduces denials and compliance risks.

Error 2: Improper Use of Modifier AT (Active Treatment)

Medicare requires the AT modifier to confirm that chiropractic manipulation is medically necessary and part of active treatment.

Common Issues:

• Forgetting to apply the AT modifier for Medicare claims.

• Using AT for maintenance care, which is not covered.

• Applying AT to non-covered adjunct services.

How to Avoid This Error:

• Apply the AT modifier only to spinal manipulation codes for active care.

• Document measurable functional improvement.

• Update templates to prompt when AT is required.

• Clearly separate active treatment from maintenance care.

Without AT, Medicare automatically denies claims as maintenance care.

Error 3: Confusing Active Care with Maintenance Care

Medicare and commercial payers require clear separation between active and maintenance chiropractic care.

Active Care Includes:

• Improvement of function

• Reduction in symptoms

• Short-term care aiming for measurable progress

Maintenance Care Includes:

• Stabilized conditions

• No expected improvement

• Supportive or wellness care

Common Issues:

• Documentation showing no progress over several visits.

• Mislabeling maintenance visits as active care.

• Using AT modifier on maintenance claims.

How to Avoid This Error:

• Record objective improvement measures.

• Update treatment plans regularly.

• Use ABNs for maintenance care.

• Document why a visit qualifies as active care.

Clarity between the two prevents audits and unnecessary denials.

Error 4: Missing or Insufficient Chiropractic Documentation

Documentation is one of the biggest challenges in chiropractic billing.

Documentation Must Include:

• Chief complaint

• History of present illness

• Diagnosis

• Objective findings

• Regions treated

• Functional outcome measurements

• Treatment plan and goals

• Expected timeframe for improvement

Common Issues:

• No measurable outcomes

• Copy-paste notes

• Missing treatment goals

• No documentation linking diagnoses to spinal regions

• Lack of functional improvements noted over time

How to Avoid This Error:

• Use structured SOAP templates.

• Incorporate outcome tools like VAS and ROM.

• Audit documentation monthly.

• Train providers on payer-specific rules.

High-quality documentation supports medical necessity and successful reimbursement.

Error 5: Incorrect or Incomplete ICD-10 Codes

ICD-10 coding must be precise, region-specific, and medically justified.

Common ICD-10 Issues:

• Using symptom-only diagnoses

• Missing laterality

• Failing to code acute vs. chronic

• Using M99.0 codes without supporting documentation

• Using outdated or non-covered ICD codes

Examples of Region-Specific Chiropractic Diagnosis Codes:

• M99.01 – Cervical segmental dysfunction

• M99.02 – Thoracic segmental dysfunction

• M99.03 – Lumbar segmental dysfunction

• M99.04 – Sacral dysfunction

• M99.05 – Pelvic dysfunction

How to Avoid This Error:

• Match ICD-10 codes to the regions treated.

• Avoid generic or non-specific codes.

• Update ICD-10 lists annually.

• Ensure documentation supports the diagnosis.

Correct diagnoses ensure payers recognize medical necessity.

Error 6: Incorrect Billing of Non-Covered or Bundled Services

Medicare does not cover many services commonly provided in chiropractic offices, including:

• X-rays

• Therapy modalities

• Massage

• Exams

• Maintenance care

Common Issues:

• Billing Medicare for non-covered services without an ABN

• Billing separately for bundled services

• Billing therapy codes without adequate time logs

• Missing documentation of therapeutic intent

How to Avoid This Error:

• Know which services each payer covers.

• Always issue ABNs for Medicare non-covered services.

• Document start/stop times for timed therapy codes.

• Clarify services that must be bundled.

Proper handling of non-covered services protects the practice from denials and write-offs.

Error 7: Misuse of Modifier 59 and X-Modifiers

Modifier 59 is frequently misused, particularly with manual therapy (97140) and chiropractic manipulation.

Common Issues:

• Using modifier 59 when services are not truly separate.

• Applying 59 instead of more accurate X-modifiers.

• Not documenting distinct service regions.

How to Avoid This Error:

• Use XS for separate structure, XE for separate encounter, XP for separate practitioner, and XU for unusual service.

• Document clearly when services are separate.

• Review payer guidelines for appropriate use.

Correct modifier usage reduces claim rejections and audit triggers.

Error 8: Upcoding or Downcoding Chiropractic Services

Both upcoding and downcoding create compliance and financial problems.

Upcoding Examples:

• Billing higher-level CMT codes than documented.

• Billing multiple therapy modalities without justification.

• Billing higher E/M codes than documented.

Downcoding Examples:

• Underbilling for regions actually treated.

• Not billing therapy codes due to fear of audits.

• Under-reporting services that were performed.

How to Avoid This Error:

• Code according to documentation only.

• Train staff regularly.

• Conduct quarterly internal audits.

Balanced coding protects revenue and compliance.

Error 9: Incorrect Time-Based Billing for Therapy Codes

Therapy codes such as 97110, 97112, 97140, and 97035 require adherence to the 8-minute rule.

Common Issues:

• Billing units without time documentation.

• Double-counting minutes for multiple services.

• Billing two units when fewer than 23 minutes were provided.

How to Avoid This Error:

• Record exact time spent on each modality.

• Follow the 8-minute rule:

  • 8–22 minutes = 1 unit

  • 23–37 minutes = 2 units

  • 38–52 minutes = 3 units

• Use EHR built-in timers when available.

Proper time documentation ensures clean claims and minimizes payer scrutiny.

Error 10: Poor Coordination Between Providers and Billing Staff

Even skilled billers struggle when provider documentation is unclear or incomplete.

Common Issues:

• Coders guessing the correct CPT code

• Providers unaware of modifier rules

• Billers missing payer updates

• Confusion regarding therapy documentation

How to Avoid This Error:

• Hold quick weekly team discussions on issues.

• Standardize coding workflows.

• Provide continuous training.

• Consider outsourcing to chiropractic billing specialists.

Communication is central to long-term RCM success.

Best Practices to Prevent Chiropractic Coding Errors

• Use structured SOAP note templates.

• Conduct regular internal chart audits.

• Stay updated with yearly CPT and ICD-10 changes.

• Use chiropractic-specific EHR systems.

• Train staff regularly on payer rules.

• Maintain accessible coding guidelines on-site.

• Outsource to experts when needed.

These strategies reduce claim denials, protect revenue, and improve compliance.

Conclusion

Chiropractic billing is more complex than many providers realize. Small mistakes in documentation, coding accuracy, ICD-10 usage, modifiers, and time logs can significantly impact reimbursement and increase audit risk.

By understanding the most common coding errors—and taking proactive measures to prevent them—your practice can strengthen compliance, maximize reimbursement, and streamline revenue cycle performance. For billing and coding help, please connect with our billing and coding manager today!