Medical Billing - GC0 Record

By: Michael Russell

In our continuing series on medical billing, focusing on certificates of medical necessity, we'll be covering the GC0 record in this installment.

The GC0 record is sent for any patient that either sees a chiropractor or has a chiropractic procedure performed. Not all insurance carriers recognize and pay on chiropractic claims so it is best to check with your carrier before attempting to send a GC0 record. If the record is not recognized and the claim is sent with one, there is a good chance that the claim will be denied. What follows are the fields of the GC0 record.

GC0 field 1, positions 1 - 3, is the record type. This needs to be filled in with GC0.

GC0 field 2, positions 4 - 5, is the sequence number in claim. Because claims can have more than one GC0 record, each one has to have its own sequence number.

GC0 field 3, positions 6 - 22, is the patient ID. This must be the same ID number that is transmitted in the CA0 record and all subsequent records.

GC0 field 4, positions 23 - 39, is the line item control number. This is the control number that is assigned to each item in the claim. These are usually assigned sequentially.

GC0 field 5, positions 40 - 47, is the initial treatment date. This date needs some explanation. This is not the date when the patient first saw the chiropractor. This is the date that the chiropractor first treated the patient, which in most cases is what the claim is billing. This date can be transmitted either in yyyymmdd or mmddyyyy format, depending on the requirements of the carrier.

GC0 field 6, positions 48 - 55, is the date of the last x-ray. This field is self explanatory. This date format follows the same rules as field number 5. One note. If no x-ray was done then this field must be left blank.

GC0 field 7, positions 56 - 62, it the treatment in series. This is the number of the treatment in the series if there has been more than one treatment. The whole field must be filled, so if this is treatment number 2, then the field must be transmitted as 0000002.

GC0 field 8, positions 63 - 69, is the subluxation level. The first thing that needs to be explained here is what subluxation is. Subluxation is when one of the bones in your spine moves out of position. This field basically transmits the amount of that subluxation.

GC0 field 9, position 70, is the treatment period. This is a one character code designating how long the patient's treatment has been ongoing.

GC0 field 10, positions 73 - 74, is the treatments this month, which is self explanatory. Max number can be 31.

GC0 field 11, position 75, is the nature of condition. This is a one character code designating how the condition occurred.

GC0 field 12, positions 76 - 83, is the date of manifestation. This is the date when the condition occurred.

GC0 field 13, position 84, is the complication indicator. This is a Y or N field to designate if there were complications.

GC0 field 14, positions 85 - 244, is the symptoms description. This is a narrative explanation of any symptoms the patient is having.

GC0 field 15, position 245, is the x-ray indicator. This is checked if x-rays were taken.

GC0 field 16, positions 246 - 320, is filler national and must be filled with spaces.

In our next installment of medical billing, we'll continue with our review of the G records.