QUESTION: I've heard that ICD-10 codes updated on Oct. 1, 2016. Did this update all the codes and what changes do I need to make as a chiropractor, if any?
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place. However, it does not affect all 69,000 codes, and depending on the common codes used in your practice, may result in minor or no changes to your common code usage.
Just as when ICD-10 first transitioned, the date of service determines the codes. If the date of service was Sept. 30, 2016 or earlier, use the previous codes; use the new codes for services performed on and after Oct. 1, 2016. Do not combine a single claim form with an old and new code; send them separately.
To date, 1,974 new ICD-10-CM codes have been proposed for the 2017 ICD-10 release (effective date: Oct. 1, 2016). Of that number, there are 313 deletions and 351 revised codes. This may seem like a number of changes, but for perspective, note the following as the most likely changes that will affect chiropractic providers.
For cervical spine disc codes, there is further specificity of disc level for mid-cervical spine. Instead of one code for mid-cervical disc displacement, M50.22, there are now specific codes for each disc: C4-5, C5-6 and C6-7.
For instance, for disc displacement of mid-cervical spine, there is now M50.221, Other cervical disc displacement at C4-C5 level; M50.222, Other cervical disc displacement at C5-C6 level; M50.223, Other cervical disc displacement at C6-C7 level; and M50.220, Other cervical disc displacement unspecified level.
This same type of code distinction appears for all cervical spine disc codes, including disc disorder with myelopathy, disc disorder with radiculopathy, disc displacement, disc degeneration, other disc disorders, and unspecified disc disorders. This update alone adds 24 new codes and deletes six codes.
Codes for TMJ disorders and jaw sprain also were completely updated and changed in order to identify the condition as right, left or bilateral. Furthermore, there are new codes for bilateral extremity nerve lesions such as carpal or tarsal tunnel syndrome; lesion of radial, median, sciatic, femoral, popliteal or plantar nerves; mononeuropathies and causalgia.
There are also new codes for bunions and bunionettes; new codes for pain in the joints of the hands; and an update to coding for "post-procedural status," which is the code for postsurgical issues such as pain or other related dysfunction. That new code is Z98.890.
Just like when the codes first transitioned, which did not lead to the nonpayment of claims or a national panic, these changes simply constitute an updated form of communication to best describe the condition being treated. The better and more detailed description will always lead to getting the appropriate levels of care allowed and paid.
There are some other code changes that may impact you, depending on the type of practice you operate and the care you provide. These changes relate to conditions such as high cholesterol, depression and mood disorders, testicular pain, and sarcopenia.
To those who request it, I will send a list of the common codes for chiropractic as noted above (about three pages in length); and, if you would like, the complete list of code changes (yes, all 2,500, which is 71 pages). Send your request for one or both documents to sam@hjrossnetwork.com.
Editor's Note: Feel free to submit billing questions to Mr. Collins at sam@hjrossnetwork.com. Your question may be the subject of a future column.
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