Samuel A. Collins
Question: I’ve heard the new diagnosis codes updated again. What changes affect DCs?
In chiropractic, changes are always occurring, and this year is no different. As I was taught by my father, “Chiropractic is a practice and not a perfect,” and for that reason, we should always continue to learn, update and change.
As I am sure many of you are aware, diagnosis coding updates occur every October 1st. In fact, although they are next-year changes, their effective date is Oct. 1 of the year prior. The total number of diagnosis codes now exceeds 70,000, encompassing 73,764 specific diagnoses. For 2024, there are 526 new codes, 22 revisions and 25 deleted codes. This number is actually small compared to 2023; that had 1,176 new codes and 287 deletions.
That said, the important factor is how many code changes affect common chiropractic coding. For instance, in a previous update, the entire coding for cervical disc was revised. Another had updates to lower back pain, headaches, myalgia, etc.
Migraine Codes
This year’s updates have no revisions to any common codes, but do have some additions to migraines. There are now four new migraine diagnosis codes to describe chronic migraines. Chronic migraine symptoms are the same as those of episodic migraines, but chronic migraines last longer and/or happen more often.
These new codes relate to at least 15 episodes in a month of a headache or migraine, with at least eight of the days including migraine features. This would be present for at least three months. The new codes are:
- G43.E01 Chronic migraine with aura, not intractable, with status migrainosus
- G43.E09 Chronic migraine with aura, not intractable, without status migrainosus
- G43.E11 Chronic migraine with aura, intractable, with status migrainosus
- G43.E19 Chronic migraine with aura, intractable, without status migrainosus
Intractable migraine, also referred to as status migraine or status migrainosus, is a severe migraine that has continued for more than 72 hours and has been refractory to usual therapies for migraine. Essentially, it is a headache that does not go away. “Intractable” indicates periods of no headache that may be recurring.
These new migraine codes add a greater level of specificity to describe migraines, which is already a large group of codes in the G43 category. Previously, “chronic” was not specifically noted and now has its own set and further specifies that diagnosis by answering the intractable / not intractable and status migrainosus questions.
If you have never researched the vast array of migraine codes, do a search of G43; there are some 50 variations. Certainly, you can provide much more detail than simply defaulting to R51.9 for “headache.”
As far as common codes used for conditions related to chiropractic care, this in my opinion is the breadth of this year’s update. However, there are a few that may also play a role as far as complications or comorbidities when accompanied with other conditions treated by a chiropractor.
Parkinson’s Codes
The updates include five new codes to report Parkinson’s disease (G20), which will boost specificity (granularity) by adding information about dyskinesia and fluctuations. The standard global Parkinson’s code (G20 Parkinson’s disease) was deleted and replaced with these five codes:
- G20.A1 Parkinson’s disease without dyskinesia, without mention of fluctuations
- G20.A2 Parkinson’s disease without dyskinesia, with fluctuations
- G20.B1 Parkinson’s disease with dyskinesia, without mention of fluctuations
- G20.B2 Parkinson’s disease with dyskinesia, with fluctuations
- G20.C Parkinsonism, unspecified
Patients with Parkinson’s disease commonly experience recurring and chronic lower back and spinal pain, often due to poor posture, falls, etc., and this underlying condition complicates and retards recovery of spinal pain conditions.
Hypertension Code
There is also a new code for resistant hypertension. This is defined as blood pressure above the patient’s goal despite the use of three or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. This new code is I1A.0 Resistant hypertension. Certainly, a person may need some other approaches such as diet, lifestyle and chiropractic care.
Other Code Changes
Osteoporosis diagnosis also had some additions for osteoporosis specific to the pelvis with fracture. There are also multiple new codes related to the entering of a foreign body into a natural orifice. I will leave that one alone and simply note you will may find some amusement by doing a search in the W44 category.
Even though this year’s update has no changes to common coding, it is always important to stay abreast of changes and have a resource to assure your coding knowledge and use are current and best practice.
Editor’s Note: Have a billing question? Submit it via email to Sam at sam@hjrossnetwork.com. Your question may be the subject of a future column. Note that submission of a question is acknowledgment that it may be referenced (anonymously) in his column.
