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ICD-10 code changes for 2021, effective this month

Rebecca Scott
There are several new diagnosis ICD-10 code changes commonly used in chiropractic, and we outline some of the changes that are expected...

There are several new diagnosis ICD-10 code changes commonly used in chiropractic, and we outline some of the changes that are expected…

As we prepare for the changing of the season, pulling out coats ahead of the cold weather, it’s also the time to pull out current coding books. Because ICD-10 code changes are controlled by the government, they work on a government fiscal year, Oct. 1-Sept. 30.

New codes go into effect prior to CPT code changes that happen every January. For that reason, we must be diligent in reviewing our diagnosis codes and habits to prepare for the updates. This year there are several new diagnosis codes commonly used in chiropractic and some that have been discontinued. Here we outline some of the changes that are expected to affect doctors in this profession.

Chapter 13 — diseases of the musculoskeletal system

Usually, the most dog-eared pages in a chiropractor’s coding book are from this chapter of codes. For 2021, this chapter has 57 new codes and 3 deleted codes (M92.50, M92.51, and M92.52 Juvenile osteochondrosis). Many of these new codes simply add options for “other specified sites” providing another option for individual areas that didn’t exist before. Most of these fixed the problem of your only option being a specific site (like a certain joint) or an unspecified site. Now, these changes open the possibility for “another specified site” if not listed with a code.

The codes for TMJ have been expanded to describe other specified sites of arthritis and osteoarthritis, as well as arthritis and arthropathy of the TMJ (e.g., M266.51, Arthropathy of right temporomandibular joint). In addition, there are added bilateral and bone-specific codes for juvenile osteochondrosis of the tibia and fibula such as M92.523 (Juvenile osteochondrosis of tibia tubercle, bilateral). Be sure to have your codebook in front of you.

Avoid ‘unspecified’ and ‘not elsewhere classified’ if possible

Codes with “unspecified” or “not elsewhere classified (NEC)” notated in the title are for use when the information in the medical record provides detail for a code that does not exist in ICD-10. The provider is then left with choosing a more generalized code, or in other words, it’s “as good as it gets.” Last year they chose to expand the code this way for diagnosing myalgia.

If the location of the myalgia were not the head and neck but another specific region, you would most likely use code M79.18 – ‘other site.’ This means the medical record provides detail for which a specific code does not exist. Nobody wants to say the ‘medical record is insufficient’ so when possible, AVOID using “unspecified” diagnosis codes. For this, we are grateful that many of the code families have been updated to include this option.

These are a collection of some of the updated, “other specified” codes added for this year:

Here are the changes to the TMJ family of codes:

Changes to the description of headache

In ICD-10, headache-related conditions reside in Chapter 6, Diseases of the Nervous System, and most begin with the letter G. An example is G44.201, described as Tension-type headache, unspecified, intractable. Don’t worry…these haven’t changed. But a review of this code in your coding resource indicates an “Excludes 1” remark for Headache code R51.

A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1. So, we are taught not to use R51 at the same time as a G level headache code.

Now enter the updated ICD-10 code set. R51 has been deleted as of October 1, 2020. There are two more specific codes to replace it.

ICD-10 additional changes

There are almost 600 changes that include 490 new codes and 47 revised codes in the update this year. We have only elaborated on the ones that are most likely to affect chiropractors. In total, there are now 72,606 codes for you to choose from. Please review all your codes on an annual basis and ensure they are up to date to avoid claim denials after Oct. 1. Don’t forget to update these in your practice management software for all billing Oct. 1 or later.

Remember to read the Instructions. Each year the Coding Guidelines are updated. Be sure you understand the terms such as ‘and,’ ‘code also’ and the recently updated term ‘with’ (see page 12 of 120) of the ICD-10 CM Official Guidelines for Coding and Reporting. 

Because making the right coding choices saves time and money, learn to get your chiropractic coding done right, the first time. Understand exactly what is necessary to protect your practice, and maximize your profitability – quickly, and easily.

Rebecca Scott is a certified professional coder who began her chiropractic career in 1989. She graduated in 2008 with an associate’s degree in accounting and is a licensed clinical chiropractic assistant in the state of Maine. She’s a member of the Lewiston Chapter of the American Association of Professional Coders (AAPC) and is both a certified specialist working in curriculum development and an individual client consultant for KMC University. She or any of her teammates can be reached at info@kmcuniversity.com or by calling 855-832-6562.

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