Chiropractic medical billing involves error-free coding of diagnostic procedures with the correct ICD-10 codes. A chiropractor’s first goal is to find out what is wrong and to make a diagnosis. The diagnosis helps to determine which type of treatment you need and what needs to be addressed. One of the most important things for the chiropractor to do is to identify the source of pain, which will help in providing the appropriate treatment that can effectively reduce the pain and promote healing as quickly as possible.
Documenting the diagnosis is also as crucial as identifying the source of pain. The diagnoses you make represent your patient’s condition to the insurance company, and must be extremely accurate. Patients may approach you with severe low back pain, severe leg pain, constant leg numbness and foot drop. However, without a diagnostic test, it cannot be assumed that these symptoms are the result of disc involvement. Similarly pain, numbness and tingling in the thumb need not necessarily mean it is carpal tunnel syndrome.
ICD-10 contains five times as many codes as ICD-9. ICD-10-PCS codes for chiropractic procedures have seven characters, each representing a particular aspect of the procedure. These seven characters represent Section, Body system, Root operation, Body region, Approach, Method and Qualifier respectively. Chiropractic physicians can typically use codes from just four or five of the 21 chapters available in ICD-10-CM.
A list of the most commonly used ICD-10 codes will be of great help for chiropractic offices as well as for medical coding companies to perform their tasks more easily and to avoid confusion with similar codes.
Here is a short list of the most used ICD-10 codes.
Subluxation
Though most chiropractors use ICD-9 “739” codes for subluxation, it is a code for conditions that do not have a code. With ICD-10, the most likely scenario is that M99.0 will replace 739; and S13, S23, and S33 will replace 839.
- 11 – Subluxation complex (vertebral) of cervical region
- 12 – Subluxation complex (vertebral) of thoracic region
- 13 – Subluxation complex (vertebral) of lumbar region
Headache
- 201 – Tension-type headache, unspecified, intractable
- 209 – Tension-type headache, unspecified, not intractable
- 001 – Migraine without aura, not intractable, with status migrainosus
- 009 – Migraine without aura, not intractable, without status migrainosus
Disc disorders
- 11 – Cervical disc disorder with radiculopathy, occipito- atlanto- axial region
- 12 – Cervical disc disorder with radiculopathy, mid-cervical region
- 14 – Intervertebral disc disorders with radiculopathy, thoracic region
- 16 – Intervertebral disc disorders with radiculopathy, lumbar region
- 17 – Intervertebral disc disorders with radiculopathy, lumbosacral region
Sprains and strains
- 4XXA – Sprain of ligaments of cervical spine, initial encounter
- 1XXA – Strain of muscle, fascia and tendon at neck level, initial encounter
- 4XXA – Sprain of ligaments of cervical spine, initial encounter
- 1XXA – Strain of muscle, fascia and tendon at neck level, initial encounter
- 3XXA – Sprain of ligaments of thoracic spine, initial encounter
- 41XA – Sprain of ribs, initial encounter
Migraine
- 001 – Migraine without aura, not intractable, with status migrainosus
- 009 – Migraine without aura, not intractable, without status migrainosus
- 109 – Migraine with aura, not intractable, without status migrainosus
- 111 – Migraine with aura, intractable, with status migrainosus
Spinal stenosis
- 03 – Spinal stenosis, cervicothoracic region
- 06 – Spinal stenosis, lumbar region
- 07 – Spinal stenosis, lumbosacral region
It is highly recommended to use the diagnoses codes that accurately represent the patient’s presenting complaint and underlying condition. Functional measurements that change the diagnosis after the initial assessment must also be recorded to clearly document the patient’s actual progress. Any change in diagnosis must be noted in the chart notes.
Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.