By making sure you understand ICD-10 chiropractic coding basics, you will have a better understanding of how to protect your practice from coding mistakes.
Remember to always verify each code before implementing it in your own use. The Centers for Medicare and Medicaid Services created an ICD-10 Code Lookup tool you can use as part of your own research. This system also allows you to search for specific ICD-10 description keywords and obtain a corresponding code.
Common chiropractic codes
ICD-10 is a very detailed, descriptive system. The new codes describe the patient’s specific condition and include information about symptoms, location on the body, and other pertinent information.
As explained by ChiroCare, one primary diagnosis is claimed along with any other conditions being treated as part of the same claim.1
Here are a few examples of commonly diagnosed ICD-10 codes along with their corresponding code descriptions: 2
- R51 Headache
- G44.201 Tension-type headache, unspecified, intractable
- G44.209 Tension-type headache, unspecified, not intractable
- M54.6 Pain in thoracic spine
- M41.114 Juvenile idiopathic scoliosis, thoracic region
- M54.5 Low back pain
- G56.01 Carpal tunnel syndrome, right upper limb
- G56.02 Carpal tunnel syndrome, left upper limb
- M25.511 Pain in right shoulder
- M25.512 Pain in left shoulder
If you know the ICD-9 code, you can use the American Chiropractic Association’s ICD-10 Code Conversion tool to find the ICD-10 equivalent. ChiroCare offers a free list of frequently-used chiropractic codes with these and others. You may want to add many of these to your own list.
Just like the codes themselves, ICD-10 code descriptions are standardized and may be used to refer to a specific condition. Remember that these codes may be as many as seven characters long, with the first three characters representing the category, the next three providing a bodily location and severity level and the final character providing information about the state of the condition’s treatment or level of medical necessity.
ICD-10’s seventh character
Now that you have determined your patient’s diagnosis, you must carefully document detailed information about the case. This detailed documentation will help you select the most appropriate diagnosis codes and maintain compliance with ICD-10.
These new codes also provide you with the opportunity to specify information about medical necessity and say something about the patient’s treatment plan.²
The seventh character of the ICD-10 code is generally an A, D, or S, and is specific to injuries. These three different letters have specific meanings:1
- Initial encounter (A)—Use this character in your code when the patient is actively receiving treatment. Generally, this claims medical necessity for care and suggests that more than one visit is required.
- Subsequent encounter (D)—This is either used for supportive care claims or maintenance care.
- Sequela (S)—This indicates that the present condition is a result of a prior, no longer existing condition.
Know your codes and practice smart coding
If a specific condition has not been diagnosed, descriptive codes may be used to indicate any symptoms the patient may be experiencing. Before coding, make sure any necessary tests have already occurred. Do not choose a diagnosis code indicating a specific condition until you are absolutely certain that this condition applies to your patient.
Always verify each code before implementing it in your own practice. This article presents only a brief overview of ICD-10 coding features that are unlike those of ICD-9. For a more complete explanation of ICD-10 coding, the resources at acatoday.org/icd10 are a good starting point.
References
1 ChiroCare. “ICD-10 for the Chiropractic Procrastinator.” http://www.chirocare.com/wp-content/uploads/2015/01/ICD-10-Procrastinators-GuideFINAL.pdf. Accessed October 2015.
2 Centers for Medicare & Medicaid Services. “ICD-10 Code Lookup.” https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx. Published March 2014. Accessed October 2015.