Pulmonology Coding Alert

Question: A patient of ours keeps asking us to write a chiropractic referral because she believes the chiropractor will perform services that can help her asthma. She says Aetna won't let her see the chiropractor without a referral and since the pulmonologist is treating her asthma, she wants him to write it. The pulmonologist doesn't believe the chiropractic treatment is medically necessary so he won't write the referral, but the patient keeps calling. Can you advise?

Codify Subscriber

Answer: It sounds like the patient may have some confusion about what's required and what's covered for her condition. Most payers do not require a specialist to write a referral before a patient can have chiropractic services. In addition, Aetna does not consider asthma a covered diagnosis for chiropractic services.

In black and white: Aetna's policy for chiropractic services states, "Manipulation is considered experimental and investigational when it is rendered for non-neuromusculoskeletal conditions (e.g., attention-deficit hyperactivity disorder, asthma, autism spectrum disorder, dysmenorrhea, epilepsy, and gastro-intestinal disorders, and menopause-associated vasomotor symptoms; not an all-inclusive list) because its effectiveness for these indications is unproven."

If the patient is persistent in calling your office, explain that the pulmonologist doesn't deem chiropractic services medically necessary for asthma. Even if the pulmonologist did determine that chiropractic services would benefit the patient, you can show the patient Aetna's policy indicating that chiropractic is not considered payable for patients with asthma.