The new 2025 ICD-10 codes for chiropractic

Choosing a diagnosis code based on intuition alone is insufficient. The clinical rationale for each diagnosis must be clearly written, included in your care plan and recorded in the patient’s chart notes.

The official ICD-10 code set and guidelines for 2025 have been released, took effect on Oct. 1, 2024, and remain in effect until Sept. 30, 2025.¹ The 2025 set now includes 78,000 ICD-10 codes. There are 252 new codes, 13 revised and 36 deleted.

ICD-10 codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established. While specific diagnosis codes should be reported when they are supported by the available documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each patient encounter should be coded to the highest level of certainty. If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis.

Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out” “working diagnosis” or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results or other reasons for the visit.

It is important for providers to fully describe each encounter. When submitting insurance claims, only report diagnoses that were actively addressed. Contributory conditions should be documented. It should be obvious from the patient record that all reported diagnoses were addressed.

To help you prepare, we’ve compiled a list below of the most relevant 2025 new codes for chiropractic practices:

There are four new ICD-10 codes that relate to the lumbar region, lower extremity pain and disc degeneration.

These replace ICD-10 code M51.36, a five-digit code, with six-digit codes:

1. 360: Other intervertebral disc degeneration, lumbar region with discogenic (axial) back pain only
2. 361: Other intervertebral disc degeneration, lumbar region with lower extremity pain (leg pain with referred sclerotomal pain) only
3. 362: Other intervertebral disc degeneration, lumbar region with discogenic (axial) back pain and lower extremity pain (leg pain with referred sclerotomal pain) only
4. 369: Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain

There are four new ICD-10 codes that relate to the lumbosacral region, lower extremity pain and disc degeneration.

These replace ICD-10 code M51.37, a five-digit code, with six-digit codes:

1. 370: Other intervertebral disc degeneration, lumbosacral region with discogenic (axial) back pain only
2. 371: Other intervertebral disc degeneration, lumbosacral region with lower extremity pain (leg pain with referred sclerotomal pain) only
3. 372: Other intervertebral disc degeneration, lumbosacral region with discogenic (axial) back pain and lower extremity pain (leg pain with referred sclerotomal pain) only
4. 379: Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or lower extremity pain

The following provides description of terms listed within the above new ICD-10 codes:

• Discogenic pain: This type of back pain originates in the intervertebral disc. It’s typically caused by degenerative changes to the disc. These structural defects can result in inflammation and biochemical instability.
• Axial back pain: This type of pain is confined to the lower back region.
• Sclerotomal pain: This type of pain is usually deep and dull and radiates along the sclerotome.

There is one new ICD-10 code that relates to low back muscle dysfunction:

1. 85: Dysfunction of the multifidus muscles, lumbar region

There are five new shoulder ICD-10 codes:

1. 90: Unspecified synovitis and tenosynovitis, unspecified site
2. 91: Unspecified synovitis and tenosynovitis, shoulder
3. 911: Unspecified synovitis and tenosynovitis, right shoulder
4. 912: Unspecified synovitis and tenosynovitis, left shoulder
5. 919: Unspecified synovitis and tenosynovitis, unspecified shoulder

There are four new upper arm ICD-10 codes:

1. 92: Unspecified synovitis and tenosynovitis, upper arm
2. 921: Unspecified synovitis and tenosynovitis, right upper arm
3. 922: Unspecified synovitis and tenosynovitis, left upper arm
4. 929: Unspecified synovitis and tenosynovitis, unspecified upper arm

There are four new forearm ICD-10 codes:

1. 93: Unspecified synovitis and tenosynovitis, forearm
2. 931: Unspecified synovitis and tenosynovitis, right forearm
3. 932: Unspecified synovitis and tenosynovitis, left forearm
4. 939: Unspecified synovitis and tenosynovitis, unspecified forearm

There are four new hand ICD-10 codes:

1. 94: Unspecified synovitis and tenosynovitis, hand
2. 941: Unspecified synovitis and tenosynovitis, right hand
3. 942: Unspecified synovitis and tenosynovitis, left hand
4. 949: Unspecified synovitis and tenosynovitis, unspecified hand

There are four new thigh ICD-10 codes:

1. 95: Unspecified synovitis and tenosynovitis, thigh
2. 951: Unspecified synovitis and tenosynovitis, right thigh
3. 952: Unspecified synovitis and tenosynovitis, left thigh
4. 959: Unspecified synovitis and tenosynovitis, unspecified thigh

There are four new lower leg ICD-10 codes:

1. 96: Unspecified synovitis and tenosynovitis, lower leg
2. 961: Unspecified synovitis and tenosynovitis, right lower leg
3. 962: Unspecified synovitis and tenosynovitis, left lower leg
4. 969: Unspecified synovitis and tenosynovitis, unspecified lower leg

There are four new ankle and foot ICD-10 codes:

1. 97: Unspecified synovitis and tenosynovitis, ankle and foot
2. 971: Unspecified synovitis and tenosynovitis, right ankle and foot
3. 972: Unspecified synovitis and tenosynovitis, left ankle and foot
4. 979: Unspecified synovitis and tenosynovitis, unspecified ankle and foot

A joint effort between the DC and the office billing/coding manager is essential to achieve complete and accurate documentation, code assignment and reporting of diagnoses and procedures. The importance of consistent, complete documentation in the patient record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.

In ICD-10, the trauma episodes of care are designated by three types of encounters. Initial encounter, subsequent encounter and sequelae.

Use the letter A for initial encounter. This occurs when the patient is receiving active treatment for the condition, and you are the first provider the patient visits for the present condition.

Use the letter D for subsequent encounters. This is for follow-up visits after the patient has seen another provider.

Use the letter S for sequela. Sequela is a late effect problem as a result of the original problem. This is used for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. When using sequela, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The S is added only to the injury code, not the sequela code. There is no time limit on when a sequela code can be used.

You’ve probably heard of CPT code bundling. This is a process that some health plans use to deny claims based on the CCI bundling edits. ICD-10 code bundling is another process that health plans use to deny claims based on the “Excludes 1” note within the official ICD-10 guidelines. Excludes 1 note means “not coded here.” Excludes 1 is used when two conditions cannot occur together.

Five examples

Example 1: M54.50 (low back pain) has an excludes 1 indicator with M54.41 (sciatica with low back pain, right side) and M54.42 (sciatica with low back pain, left side).

Example 2: M54.50 (low back pain) has an excludes 1 indicator with S39.012 (strained muscles of the lower back).

Example 3: M51.16 (lumbar disc disorder with radiculopathy) has an excludes 1 indicator with M54.16 (lumbar radiculopathy).

Example 4: M54.2 (neck pain) has an excludes 1 indicator with M50.122 (cervical disc disorder with radiculopathy at C5-C6).

Example 5: M54.6 (thoracic pain) has an excludes 1 indicator with M51.34 (thoracic disc degeneration).

If both codes are submitted a denial may occur.

Final thoughts

It’s important for DCs and healthcare professionals specializing in musculoskeletal conditions to stay informed about the latest ICD-10 code updates. These changes will impact diagnosis coding and reimbursement processes. Schedule a training session with all DCs and staff members to review the new 2025 ICD-10 code set and guidelines. Make sure to enter the training details (e.g., who attended, topics) into your billing and coding compliance training log.

MARTY KOTLAR, DC, CPCO, CBCS, COF, is the president of Target Coding. Over the last 15 years, Target Coding has helped hundreds of DCs with compliance as it relates to billing, coding, documentation, Medicare and HIPAA. Kotlar is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance publications and a guest speaker at many state association conventions. He can be reached by phone at 800-270-7044, by email at drkotlar@targetcoding.com or by visiting targetcoding.com.

Reference

1. ICD-10-CM Official Guidelines for Coding and Reporting FY 2025. Updated October 1, 2024. (October 1, 2024 – September 30, 2025). CMS website. https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf. Accessed December 18, 2024.