Documentation and coding of kinetic chain disruptions

We address nerve interference everyday in our practices. Although neurological disorders are at the core of what we treat, musculoskeletal disorders are much more common in our patient population.

We are holistic doctors. As such, we look at the condition’s cause as not being a mere isolated problem but rather the sum of several breakdowns within the body. The conversion of a global problem into separate diagnosis codes (in this example, coding of kinetic chain disruptions) proves difficult when reporting holistic conditions to an insurance carrier that views the world differently than we do.

Medical decision-making (MDM) reflects complexity in establishing a diagnosis, assessing the status of a condition and/or selecting a management option.¹ Our medical decision-making incorporates addressing the cause of the problem from the ground up. Understanding the kinetic chain concept is essential to diagnosing and treating patients effectively. Using MDM will help you better understand the cause of your patient’s pain and determine the correct process for treating the patient effectively.

Kinetic chain disruptions occurs when there is an interruption in the coordinated movement of muscles, joints and connective tissues. The overlapping segments are joined by connective tissue, creating a system whereby movement in one region or area of the body will affect another regional movement. This can affect the body’s ability to transfer force efficiently, leading to compensatory patterns, pain or even injury. For example, a dysfunction in the ankle can lead to compensatory adjustments in the knee, hip and spine, creating a ripple effect of imbalances and discomfort. For DCs, proper documentation and coding of kinetic chain disruptions are critical for effective patient care, communication with other healthcare providers and ensuring accurate billing and insurance claims.

Musculoskeletal disorders, such as arthritis, tendinitis or disc injuries, are more common because they directly affect the structures we use daily for movement, posture and physical support. Injuries, poor posture, repetitive stress and aging all contribute to the high prevalence of these conditions, which are often the main reasons patients seek chiropractic care.

The International Classification of Diseases (ICD) uses alphanumerical codes to explain the causes and consequences of human disease and death worldwide via reported and coded data.² The rules of ICD coding include coding to the highest specificity known by the provider. Coding signs and symptoms are only acceptable if that is all you know. Conditions, such as altered gait, degenerative arthritis, muscle weakness or hyperpronation syndrome of the feet, may slow down the recovery process of a patient. According to the World Health Organization’s (WHO’s) coding rules, complicating factors that affect patient care should always be listed last in the diagnosis list.³

Knowledge of the diagnostic codes and the rules that govern them is crucial to proving the medical necessity of our treatment and gaining proper reimbursement. For example, our office frequently encounters upper and lower cross syndromes. A visual inspection, orthopedic and neurological tests, range-of-motion measurements and palpation. These findings may yield information leading us to determine the patient suffers from a chronic sprain and strain of the cervical, lumbar and thoracic regions, which is associated with muscle weakness in several sites, an altered gait and hyperpronation syndrome of the feet. A physician who is not well versed in coding may indicate the patient has cervicalgia (neck pain), lumbago (low back pain) and middle back pain (dorsalgia). Since our documentation and coding do not indicate the true cause, instead of applying the rules of coding and specific codes, we will arrive at a different visual if we paint a picture with the codes. The example of the specific ICD-10 code set then would result in the following codes in this order:

1. 4xxA: Cervical sprain
2. 5xxA: Lumbar sprain
3. 3xxA: Thoracic sprain
4. 1xxA: Cervical strain
5. 012A: Lumbar strain
6. 012A: Thoracic strain
7. 01: Segmental and somatic dysfunction cervical
8. 03: Segmental and somatic dysfunction lumbar
9. 02: Segmental and somatic dysfunction thoracic
10. 89: Other abnormalities of gait and mobility
11. 2: Plantar fasciitis/plantar fascial fibromatosis
12. 59: Deconditioning of muscles, multiple sites

We are not using complex coding to merely use these codes but to communicate this is indeed a complicated case. The treatment for such a case will be determined by a greater degree of examination, data analysis and a conclusion about the most appropriate treatment process to address the multitude of problems present.

In our holistic practice, we aim to identify and treat the cause of dysfunction rather than simply address its symptoms. Our goal is to optimize the body’s natural healing processes. By realigning not only the spine and joints but also our documentation and coding of the true nature of the patient’s condition, we can better communicate our unique approach to patient care.

Final thoughts

Each patient is unique, and various interconnected factors influence their body’s ability to heal and maintain health. Through careful diagnosis and individualized treatment plans, you aim to improve the lives of your patients by focusing on the root causes of their health concerns.

Communication of these facts will strengthen your standing in the healthcare industry, which seeks to increase outcomes and decrease costs. Holistic care must also include “holistic documentation and coding” to improve communication with insurance carriers, governing bodies and our peers.

MARIO FUCINARI, DC, is a certified professional compliance officer, certified physician practice manager, certified insurance consultant and a Medicare carrier advisory committee member. As a member of the Foot Levelers Speakers Bureau, Fucinari travels throughout the year speaking to audiences across the U.S., sharing his chiropractic expertise and insights into using custom three-arch orthotics for optimal care. For further information, email doc@askmario.com or visit askmario.com.

References

1. Coding for Evaluation and Management Services: Answers to Common Questions. E/M Services. FAQs. American Academy of Family Physicians (AAFP) website. https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management.html. Accessed December 11, 2024.
2. ICD-11 International Classification of Diseases 11^th The global standard for diagnostic health information. May 2024. https://www.who.int/standards/classifications/classification-of-diseases. WHO website. Accessed December 11, 2024.
3. ICD-10-CM Official Guidelines for Coding and Reporting FY 2025. Updated October 1, 2024. https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf. Accessed December 11, 2024.