Starting October 1, 2018, a new ICD-10 code set went into effect for chiropractors. All chiropractic services provided after this date need to be reported using the new codes. With the increasing scrutiny of chiropractic claims, chiropractic medical billing services are a practical option to ensure accurate coding and appropriate reimbursement.

ICD-10 Code Updates for Chiropractic Services

The most notable code ICD-10 code changes for doctors of chiropractic pertain to myalgia and muscular dystrophy.

  • Myalgia: A general term used for muscle pain arising from a wide variety of causes, myalgia may be classified as short-term or long-term. Short-term myalgia is caused by muscle cramps, muscle overexertion, and pulled muscles, while chronic or long-term myalgia is more damaging as it may affect tendons, ligaments, connective tissues, bones, and even various organs.

    Chiropractic care is a safe option for muscle pain and strain. Prior to October 1, 2018, myalgia (M79.1) could be used to indicate any type of Myalgia, located anywhere. M79.1 has now been replaced with four new codes of increased specificity as follows:

    • M79.10 – Myalgia, unspecified site
    • M79.11 – Myalgia of mastication muscle
    • M79.12 – Myalgia of auxiliary muscles, head and neck
    • M79.18 – Myalgia, other site

    The descriptions for codes M7910-M7918 include specific muscle locations and illustrate that specifying anatomical locations continues to be the key to accurate reporting. To report myalgia accurately, the physician’s documentation should clearly specify the location of the patient’s myalgia.

    An article in Dynamic Chiropractic notes that M79.12 and M79.18 are the codes that will most likely used by chiropractors. When myalgia is identified, the region must be specified such as in the muscles of the head or neck. M79.18 Other site would indicate myalgia in any area other than muscles of mastication or auxiliary muscles of the head and neck.

    There are separate codes to report other muscle diseases similar to myalgia, such as fibromyalgia and myositis. Myalgia is one of the symptoms of fibromyalgia, which has its own code:

    M79.7 – Fibromyalgia

    Similarly, the ICD-10 codes for myositis (M60.0-M60.9) are separate and distinct from the codes for myalgia:

    • M60.0 Infective myositis
      Tropical pyomyositis
      Use additional code (B95-B97), if desired, to identify infectious agent
    • M60.1 Interstitial myositis
    • M60.2 Foreign body granuloma of soft tissue, not elsewhere classified

      Excludes: foreign body granuloma of skin and subcutaneous tissue (L92.3)

    • M60.8 Other myositis
    • M60.9 Myositis, unspecified

     
    ICD-10 coding for myalgia: points to note:

    • The codes for fibromyalgia and myositis should not be used in combination with the code for myalgia.
    • The Type 1 Excludes for myalgia are fibromyalgia M79.7 and myositis M60.0 to M60.9, which means that myalgia should not be reported with any of these codes.
  • Muscular Dystrophy: Muscular dystrophy is a group of inherited diseases that can cause progressive weakness and loss of muscle mass. The different types can vary in whom they affect as well as in terms of the muscles they affect and the symptoms.

    Muscular dystrophy previously had only one option – G71.0. In the 2019 code set, there are a few options to cover specific types of muscular dystrophy:

    • M71.100 Muscular dystrophy, unspecified
    • M71.01 Duchenne or Becker muscular dystrophy
    • M71.02 Facioscapulohumeral muscular dystrophy
    • M79.09 Other specified muscular dystrophies
  • Brow Ptosis: Studies have demonstrated the benefits of chiropractic care for congenital myogenic ptosis in infants. Therefore, changes in brow ptosis ICD-10 codes may be relevant for chiropractors:
    H57.8 Other specified disorders of eye and adnexa has been deleted as of Oct. 1, 2018 and replaced with the following five new codes:

    • H57.811 Brow ptosis, right
    • H57.812 Brow ptosis, left
    • H57.813 Brow ptosis, bilateral
    • H57.819 Brow ptosis, unspecified
    • H57.89 Other specified disorders of eye and adnexa
  • Puerperal psychosis or postpartum depression: Chiropractic care is also helpful for postpartum rehabilitation. In addition to physical stress caused by childbirth, many new mothers have to deal with depression. Postpartum chiropractic care helps moms recover sooner from the stresses on muscles, joints, ligaments, and the nervous system, improving physical health and keeping postpartum depression at bay. There are updates to ICD-10 codes for puerperal psychosis in 2019.
    F53 Puerperal psychosis has also been deleted and replaced with the following two codes:

    • F53.0 Postpartum depression
    • F53.1 Puerperal psychosis

All of these changes came into effect October 1, 2018. Proper clinical documentation is critical to capture the diagnosis and report the right ICD-10 codes. Documentation should specify components such as laterality, anatomical location, encounter status, underlying and associated conditions, and present signs and symptoms. Partnering with a medical billing and coding company specialized in proving chiropractic billing services will ensure optimal reimbursement while preventing submission of improper claims.