9 Chiropractic Billing & Coding Red Flags (And How to Avoid Them)

Billing and coding mistakes can disrupt cash flow, delay reimbursements, and even trigger audits. If insurance companies flag your claims too often, you risk serious financial and legal consequences.

Beyond financial setbacks, billing and coding mistakes can damage your clinic’s credibility, making it harder to build trust with both patients and insurance providers. 

Staying ahead of these issues requires a clear understanding of the biggest red flags and how to avoid them. Let’s break them down one by one so you can protect your revenue and keep your practice running smoothly.

What Are Chiropractic Coding and Billing Red Flags?

Billing red flags are errors or inconsistencies in claims that raise concerns with insurance payers and companies. These issues can lead to reimbursement denials, audits, and even fraud investigations.

Some mistakes stem from misunderstanding chiropractic billing codes, while others are caused by poor documentation, incorrect modifiers, or billing for services that aren’t medically necessary. 

Regardless of intent, repeated billing errors can put your practice under scrutiny and disrupt cash flow.

The Biggest Chiropractic Billing & Coding Red Flags

Billing errors can lead to claim denials, lost revenue, and even audits. Understanding the most common red flags can help you avoid costly mistakes and keep your practice compliant. Here are some key issues to watch out for:

1. Upcoding: Billing for a More Expensive Service Than Provided

Upcoding occurs when a claim is submitted for a higher-level service than what was actually performed. This often happens with spinal manipulation codes like:

• 98940 (one to two spinal regions adjusted)
• 98941 (three to four spinal regions adjusted)
• 98942 (five spinal regions adjusted)

For example, if you adjust three regions but bill for five (98942), you’re upcoding—even if the mistake is unintentional. Insurers treat this as overbilling, and repeated instances can result in audits or fines.

How to avoid it:

• Document treatments accurately in SOAP notes. If you adjust only three spinal regions, ensure your notes reflect that.
• Use billing software like Noterro to ensure CPT codes align with the treatment performed.

• Conduct regular audits of past claims to catch any patterns of upcoding before payers do.

Also Read: 16 Practice Management Software Features Chiropractors Shouldn’t Ignore

2. Overuse of Maintenance Therapy Codes

Most insurance companies only cover treatments that are medically necessary. If a patient’s condition is stable and care is no longer needed for recovery, continued treatment is considered maintenance therapy—insurance won’t pay for it.

Repeatedly billing 98940, 98941, or 98942 for maintenance care without justification can lead to an audit.

How to avoid it:

• Ensure your SOAP notes clearly justify each visit with measurable improvements. You can also track patient progress and flag treatments that may not meet insurance requirements, helping prevent maintenance therapy billing mistakes.
• Use objective tests like range-of-motion assessments to prove medical necessity.

Related Read: Chiropractic SOAP Notes Software for Better Patient Management

3. Canned Diagnosis Coding Without Individual Assessment

Some clinics use the same ICD-10 diagnosis codes for every patient visit, regardless of individual symptoms or progress. This creates a pattern that insurance companies view as suspicious.

For example, if every patient gets diagnosed with M99.01 (segmental dysfunction, cervical) and M54.5 (low back pain) without variation, payers may assume these diagnoses aren’t based on actual clinical findings.

How to avoid it: Avoid copy-pasting Chiro CPT codes from previous visits and make sure each diagnosis is specific to the patient’s current condition.

• Review SOAP notes before submitting claims to ensure they meet payer guidelines4. Billing for Services Without Proper Documentation

Insurers won’t pay for services that lack proper documentation. If your SOAP notes don’t clearly justify a treatment, the claim could be denied.

Some common documentation issues are:

• Missing progress notes or treatment goals.
• Lack of objective findings supporting medical necessity.
• Copy-pasting notes without updating patient conditions.

How to avoid it:

• Train staff to include measurable data (range of motion, pain scale changes) in patient records.

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5. Duplicate Billing: Accidental or Intentional?

Duplicate claims happen when a single service is billed multiple times. This could happen if you submit the same claim twice by mistake or accidentally bill for the same procedure under two different chiropractic billing codes.

How to avoid it: Use a chiropractic practice management solution to check and flag duplicate claims before submission.

6. Improper Use of Diagnosis Codes (ICD-10 Errors)

This can lead to claim denials, delayed reimbursements, or even audits. Common mistakes include:

• Using unspecified diagnosis codes when a more detailed, specific one exists. Insurance companies prefer precise coding to justify medical necessity.
• Mismatching diagnosis and CPT codes, leading to discrepancies that insurance providers flag. 
• Not updating to the latest ICD-10 version, which may result in using outdated codes that are no longer billable.

How to avoid it: Keep ICD-10 coding references updated.

7. Billing for Unlicensed or Unapproved Services

If you're a chiropractor, you can’t bill insurance for massage therapy, acupuncture, or dry needling unless it’s specifically covered under state laws and the patient’s policy. 

A few common mistakes to watch out for: billing non-covered services as chiropractic treatments, not verifying coverage before treatment, and assuming all insurers cover the same treatments—they don’t. Always double-check policies to avoid surprises.

How to avoid it:

• Only bill for services covered under your chiropractic license.
• Verify insurance policies before submitting claims.

Bonus Read: Chiropractor's Guide to Attracting More Clients: 12 Proven Strategies

8. Failure to Justify Medical Necessity

Insurance companies need proof that treatments are medically necessary. If they see repeated claims for ongoing wellness care without any documented improvement, your practice could get flagged for excessive or unnecessary billing.

How to avoid it:

• Use measurable outcomes (range of motion, pain levels) to justify ongoing treatment.
• Differentiate between medical necessity and wellness care, and let patients know when a service is self-pay.

9. Failing to Verify Insurance Coverage Before Treatment

One of the biggest billing mistakes is assuming a patient’s insurance covers a service without verifying benefits upfront. Plans vary—some exclude specific treatments, have limitations, or require pre-authorization. Some common mistakes are:

• Skipping eligibility checks and finding out too late that a service isn’t covered.
• Overlooking policy exclusions or coverage limits, leaving patients with unexpected bills.
• Not getting prior authorization for treatments that require approval.

How to avoid it: You can implement a pre-visit insurance verification process.

Protect Your Revenue from Costly Billing Mistakes

Billing mistakes—whether due to incorrect chiropractic billing codes, missed documentation, or unverified insurance coverage—can cost your practice time, revenue, and credibility. Claim denials, delayed reimbursements, and potential audits can quickly add up, creating unnecessary stress and financial strain.

The best way to stay ahead is by preventing errors before they happen. Automated billing solutions like Noterro can help by ensuring accurate documentation and correct coding, reducing costly mistakes and keeping your revenue on track. 

With the right system in place, you can focus less on administrative headaches and more on delivering quality care to your patients.

FAQs

What are the billing codes for chiropractors?

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You can use CPT codes like 98940-98942 for spinal manipulations and 97110, 97112, 97140 for therapeutic procedures.

Is chiropractic adjustment covered by insurance?

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Coverage varies by insurer and plan. Many policies cover medically necessary adjustments but exclude maintenance or wellness care.

What is a CPT code for billing?

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A CPT (Current Procedural Terminology) code is a standardized code used to describe medical, diagnostic, and therapeutic services for billing.

What is CPT code 97110 for chiropractic?

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CPT 97110 is used for therapeutic exercises aimed at improving strength, endurance, or flexibility, typically performed one-on-one with a provider.

What factors contribute to claim denials in chiropractic billing?

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Common reasons include incorrect CPT or ICD-10 codes, lack of medical necessity documentation, unverified insurance coverage, and billing for non-covered services.