Several thousand years ago, when the earth was young, the Trojan war was in progress -- an accident caused when Paris, the Trojan prince, made off with Helen, the wife of the Greek King Menelaus. The result was the Trojan War, with the Greeks raising a large army and navy in the attempt to destroy the Trojan capitol. Now, this sort of thing happens in Iowa all the time, and the worst thing that happens is usually a bar fight. Things used to be more serious until they changed the child support laws.

Anyway, after years of fighting, the Greek accomplished little, even though they used their most famous warriors, Ajax and Achilles, who were named after a can of bathroom cleaner and heel, respectively.

Then Odysseus, one of the Greek chieftains, had an idea. He convinced the Greeks to build a large wooden horse in which a number of Greek soldiers were hidden and left it on the shore as a gift, hoping that the Trojans would be stupid enough to tow it inside the walls of the city. They were. Seeing the horse sitting on the beach, they decided it was a gift from the gods (or possibly some government project) and paid someone to truck it inside the gates. During the night the soldiers came out and let the other Greeks in and they trashed the city.

I've always thought it was an interesting story. Admittedly, if someone left something like that on my front lawn, I can't imagine hauling it inside my house. My first thought would be that it might be some kind of pipe bomb, and blame it on my next door neighbor who was throwing old pizza boxes over the fence that year.

This gave rise to the saying: "timeo Danaos et dona ferentis," which, translated from the Latin, means "Beware of Greeks bearing gifts."

The moral of the story is this: If something looks too good to be true, it probably is. Which brings to mind the coding that insurance companies have assigned to us for claims filing.

Years ago, chiropractors used two codes to depict their main service, the adjustment (note that the CPT book calls it manipulation, but stick with me). The first was 97260, which the book defined as "manipulation by physician." This was interesting, in that the other code we used was for Medicare and Medicaid; this code, A2000, was defined as "manipulation by a non-physician." It's not hard to see that using this set of codes left a lot to be desired.

Enter our new code, 98940. This is supposedly just for chiropractors. As a matter of fact, when this was issued we were informed that we now had our own chiropractic code. Most chiropractors would think that it's good to finally have a code of our own. In truth, this has been no bargain, and is similar to having you own case of trench foot.

In some ways, it's even worse than the previous situation. Let me explain why.

There is another code for manipulation -- 97140. This is a general code for physical medicine and covers many different sins. For example, it can stand for either spinal manipulation or extremity manipulation. It can be used by many different practitioners, including medical doctors, osteopaths, and chiropractors. In fact, it has come to our attention that physical therapists have been using this code for Medicare billing, which was one of the reasons for the suit against HCFA.

As they say in the commercials, wait -- there's more!

It turns out that this use of this code pays more than if one used our chiropractic code. In Iowa, Blue Shield pays $18.00 for 98940, the official chiropractic code. However, they pay $24.00 for 97140. Whenever the 97140 code is used, the practitioner is paid the stated amount for his or her services, since the carriers are not supposed to discriminate for payment rates within a given code between professions.

Another note. This code can be used for non-manipulation services, as it can be time-based. The CPT book defines this code as physical medicine (first 15 minutes). That means it can include many techniques that are non-manipulatory, e.g., using a "Thumper," or even Chinese scraping techniques. In reality, 97140 is the code version of a Swiss Army knife.

However, when the 98940 code is used, a message flashes across the carrier's computer screen that says, "I am a chiropractor, please pay me less than the janitor."

When Iowa's insurance equality law was passed in the 1980s, there was a period of time when Blue Shield forced chiropractors to use something called "z-codes" in their billing. That way, they could tell that the billing came from a chiropractor. It allowed them to control payment rates. The chiropractic society in Iowa, to their credit, fought this modern-day version of the Scarlet Letter, and the insurance commissioner in this state outlawed it. Now this procedure appears to be back, only in a different form.

By the way, this makes tow straight columns in which I've said good things about our state society, which is a little like the National Association for Women (NOW) declaring a special week in honor of Mike Tyson. Although the state group and I have a relationship not unlike Captain Hook and the crocodile, I will give credit to them when warranted.

Note: While this information may lead a number of doctors to start billing manipulation under the higher-paying code, there is one caveat. 97140 is not allowed for chiropractic billing under Medicare. Until this matter is corrected, we are only allowed to bill under 98940 and its related codes.

Will it be corrected? Perhaps. When chiropractic tried to gain admission to Medicare, the government set up a study committee made up of the AMA, the AMA, and the AMA, which subsequently defined our profession as "an unscientific cult." Even though chiropractic eventually gained standing with Medicare in 1972, our position was heavily influenced by the findings this committee gave to HCFA. An example of this was the obligatory, non-covered subluxation x-ray.

If medical doctors had been treated similarly, they would have been forced to spray their patients with free doses of DDT, thus incurring extra cost, and exposing the patients to something they don't need, but that could have harmful side-effects. Fair, but harsh.

When Wilk vs. AMA ended in a chiropractic victory, common sense would dictate that HCFA would have to redefine its chiropractic coverage, i.e., enlarge its coverage in accordance with the abilities of its doctors. However, common sense and government are usually strangers. Hence, the necessity of the profession's newest action against HCFA, initiated by the ACA, and supported by the WCA and the ICA.

In future columns, I'll be dealing with these and other coding items, in an effort to understand the reasons why insurance carriers cover some services and don't cover others. The only tools needed are a set of ICDA books, a CPT manual, and a Ouija board.