QUESTION: Are there updates to ICD-10? I recall that ICD codes update on Oct. 1 of each year, although they are technically 2019 changes.
You are correct – changes for ICD-10 take place Oct. 1, as they have since the inception of ICD-10 (and for that matter, ICD-9). This year is no different, and there are several changes that will likely affect the chiropractic provider.
Some years (2016-2017 is a good example), there were significant changes and additions to cervical disc conditions, TMJ disorders, and neuralgia of the extremities, which accounted for about 75 codes that are common to the doctor of chiropractic. However, the 2017-2018 changes were minor, with only a slight update to lumbar spinal stenosis.
The updates for 2019, however, although not as great in number as 2016-2017, are significant. Here is the summary of updates. There are now 71,932 distinct ICD-10-CM codes for 2019. This represents an addition of 279 codes, 51 deletions and 143 revisions.
New Codes for Myalgia
The significant change for doctors of chiropractic are the codes for myalgia – muscle pain often referred to as myofascial pain syndrome. The most common etiology is likely chronic muscle tension, overuse or injury / trauma. The current code, M79.1, is being deleted and replaced with four new codes that provide greater specificity:
M79.10 Myalgia, unspecified site
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
Of these four codes, the most likely used in a chiropractic setting may be M79.12, which identifies an involved muscle of the neck and head; or M79.18, which identifies "other site" – a region that can be identified, but is not the muscles of mastication or muscles of the head and neck. M79.10, though a viable code, is not likely to be used, as "unspecified" is referring to a region you cannot define. Clearly, if you identify myalgia, it will be in a region and in that sense, any area other than muscles of mastication or auxiliary muscles of the head and neck would be M79.18 Other site.
The Type 1 Excludes for myalgia will remain fibromyalgia M79.7 and myositis M60.0 to M60.9, which means you do not code myalgia with any of those codes.
Muscular Dystrophy
The other change that may have some impact on DCs involves coding for muscular dystrophy. The current code, G71.0, is being deleted and, as was the case with myalgia, replaced with four codes that provide greater specificity:
G71.00 Muscular dystrophy, unspecified
G71.01 Duchenne or Becker muscular dystrophy
G71.02 Facioscapulohumeral muscular dystrophy
G71. 09 Other specified muscular dystrophies
While not common, these are conditions that are allowed to be cared for / coded under Aetna's chiropractic policy. And at the very least, they would be a complication of comorbidity of other conditions under care.
Other Code Updates That May Be of Relevance
H57.8 Other specified disorders of eye and adnexa is deleted from ICD-10 as of Oct. 1 and replaced with the following:
H57.89 Other specified disorders of eye and adnexa
F53 Puerperal psychosis is also deleted as of Oct. 1, replaced with the following two codes:
F53.0 Postpartum depression
F53.1 Puerperal psychosis
Note that all of the above changes take effect Oct. 1, 2018, and the codes are based on the date of service. If the services were performed prior to Oct. 1, then use the current codes, but all dates of service thereafter must use the newer codes. Medicare will be updating its coding to reflect these changes. Finally, note that myalgia is considered a category II level C code, which indicates moderate-term care plans.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
