It is easy to forget the power of the diagnosis code in the world of health care in regard to ICD 10 coding for chiropractic, especially as it relates to reimbursement
A virus outbreak that began in China over three months ago has now infected more than 164,000 people in the United States according the World Health Organization (WHO). WHO declared the virus a pandemic during a news conference in Geneva.
Many states and communities here at home have declared a mandatory shelter-in-place order. And somewhere hidden deep in each DC, physician’s office, hospital, nursing home, and Walmart pharmacy there is an employee scrambling to find the most appropriate diagnosis code for the latest national headline. Wait — what?
ICD 10 coding for chiropractic
The key connection between the task of coding and the headlines lie in the source of the data. One hundred sixty-four thousand people have been infected, based on data. Clinically the data is scientifically driven, but unless the Center for Disease Control (CDC), WHO, or any primary insurance company is willing to wade through each and every medical record and lab result, the source of the data comes down to a three to seven-character code. ICD 10 coding for chiropractic — an ICD-10-CM code to be precise.
In other words, the headline is really that 164,000 people have been treated within a medical facility and were assigned the diagnosis code associated with COVID-19. Is it possible that someone was treated and diagnosed, but “coded” as an unspecified virus, or the common flu?
It is easy to forget the power of the diagnosis code in the world of health care and ICD 10 coding for chiropractic. Does it really matter if the patient’s neck pain is assigned the code M54.2 (cervicalgia) or with the more definitive diagnosis S13.4XXA (sprain of ligaments of cervical spine) or even a more specific seventh character S13.4XXS to indicate that the pain is a sequela of a former sprain? Is there value in including V89.2XXS to connect this encounter to the motor vehicle accident (MVA) last summer?
I suppose a follow-up office visit and an x-ray will be paid with any one of those valid codes. But when that one claim is rolled into the insurance database that they share with the CDC in Atlanta, which shares with WHO and statistics are used for persuasion, or when you are seeking reimbursement from an indemnity payor, the devil is in the details.
In the United States, health care policy and reimbursement are framed around the term ‘medical necessity.’ Services are reimbursed when they are determined to meet, but not exceed the clinical needs of the patient. The patient with neck pain from poor posture at the computer and the patient presenting with cervicalgia due to a prior MVA with whiplash are not the same. The course of treatment and resources needed for the best outcome may not be the same. Be cautious representing these two patients as being the same by using the same diagnosis code(s) on the claims.
Defending the medical necessity of the services performed in any clinical setting relies on the accuracy of translating a clinical impression into a universal code set. The most direct path to reducing the number of CO50 denials lies in improving the diagnosis codes submitted. A general code for neck pain may not communicate the need for months of recurrent appointments for pain management as clearly as the added detail in G89.21 (Chronic pain due to trauma).
This task of translation, however, frequently falls to a computer-assisted list of favorite codes. Be sure that you leverage all the features your EHR offers to efficiently and accurately find the codes to define your patient’s complete medical story. Just because the unspecified virus code is the easiest to find, doesn’t mean it is the best choice.
Karna Morrow, CPC, RCC, CCS-P, is an implementation manager for Practice EHR. She has spent nearly three decades in the industry leading electronic health record (EHR) implementations and providing consulting and training for a variety of healthcare organizations. Morrow is a frequent contributor to highly regarded industry publications and national conferences, providing insights on practice management, coding, billing and other industry-related topics.