The ICD-10 codes changed for 2017 and include 1,974,311 deleted codes, and 425 revised codes.
These went into effect October 1, 2016. Most chiropractors, fortunately, are only affected by about 70 of these changes—none of which are groundbreaking.
But you should be aware of these changes because using deleted codes will result in denied claims. And if you are unaware of a new or revised code that is more descriptive of a condition, you might miss out on an opportunity to better establish medical necessity for your care.
October 1, 2016, also represents the end of the so-called grace period on ICD-10 coding. Before ICD-10 became official on October 1, 2015, Medicare announced it would not deny claims based on ICD-10 codes or documentation as long as the coder selected the right family, or three-character category.
It is possible we will now see audits, which include heavy scrutiny of ICD-10 documentation because the moratorium is over. Now is a good time to conduct internal audits of diagnosis documentation, or seek out training from trusted experts.
Codes to know
The following is a sampling of the ICD-10 changes you should be aware of. Several codes from chapter 6, “Diseases of the Nervous System,” were added to include bilateral conditions. For example, there is now a code to report bilateral carpal tunnel:
- 03: Carpal tunnel syndrome, bilateral upper limbs
Unfortunately, there are still no codes to indicate right, left, or bilateral radiculopathy. The additional bilateral code changes that relate to nerve problems appear to pertain to codes that begin with the letter G from chapter 6. Radiculopathy and sciatica are found in the M codes from chapter 13 (they were not changed).
Laterality should still be documented in the record even though it is not included in the code detail for these conditions.
Though this may not be diagnosed as commonly in a chiropractic office, there are now new codes for bunions and bunionettes:
- M21.611: Bunion of right foot
- M21.612: Bunion of left foot
- M21.619: Bunion of unspecified foot
- M21.621: Bunionette of right foot
- M21.622: Bunionette of left foot
- M21.629: Bunionette of unspecified foot
There are several codes for conditions of the temporomandibular joint in the 2016 version of ICD-10-CM, but they end with five characters. A sixth character was added to designate right, left, and bilateral options. See the M26.6 subcategory for specifics, but here is one example:
- M26.621: Arthralgia of right temporomandibular joint
- M26.622: Arthralgia of left temporomandibular joint
- M26.623: Arthralgia of bilateral temporomandibular joint
In the M50 category, the 2016 code set listed the mid-cervical region for many of the disc disorder codes.
However, a sixth character has been added to codes to indicate the specific level, which helps to remove any ambiguity. For example:
- M50.121: Cervical disc disorder at C4-C5 level with radiculopathy
- M50.122: Cervical disc disorder at C5-C6 level with radiculopathy
- M50.123: Cervical disc disorder at C6-C7 level with radiculopathy
In addition, many external cause codes regarding collisions with fixed or stationary objects have been deleted and replaced with codes that specify the type of vehicle. These codes start with a V and they are from Chapter 20.
There are also new codes to describe paper cuts, overexertion, and even engaging in a choking game. External cause codes are still voluntary in most circumstances. On the other hand, government programs that are voluntary now are likely to become mandatory in the future, so it may be wise to get familiar with—and begin to use—external cause codes. Ideally, their use should decrease record requests because the history information will be available through these codes on the claim form.
Evan M. Gwilliam, DC, MBA, CPC, NCICS, CCPC, CCCPC, CPC-I, MCS-P, CMPA, is executive vice president and director of education and consulting for the Chirocode Institute and is the only chiropractor certified by the AAPC as an ICD-10 trainer. He can be contacted at firstname.lastname@example.org.