What are the Spinal Subluxation Codes for Chiropractic Care of the Cervical, Thoracic and Lumbar Region

by | Last updated Feb 28, 2023 | Published on Apr 4, 2016 | Specialty Billing

Spinal Subluxation Codes
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Chiropractic medical coding involves assigning accurate ICD-10 codes for all the related conditions ensuring timely reimbursement for chiropractic medical billing service. Subluxation is a condition that is defined differently by different groups. According to echiropractic.net, a subluxation (Vertebral Subluxation) occurs when one or more of the bones of your spine (vertebrae) move out of position and create pressure on, or irritate spinal nerves. Depending on the diagnosis, chiropractors treat this condition primarily with spinal manipulation or an adjustment to the dislocated segment.

Coding the diagnosis for this specific condition has been a problem for most practices before ICD-10 implementation. CMS had earlier instructed chiropractors to use the diagnosis codes that indicate non-allopathic lesions of the spine. With ICD-9-CM codes, 739 was the category that includes “segmental and somatic dysfunction.” But the code does not even mention the word “subluxation”.

Codes that mention this specific word belong to “839” category. Though a few payers accept this code, most of them argue that it does not justify the given treatment.

739.0 converts approximately to the M99.0 codes, which are “segmental and somatic dysfunction.” Though Medicare has recommended M99.0 codes, the word “subluxation” is still missing. Though the next group of codes in the tabular List, “M99.1” subcategory is defined as “subluxation complex (vertebral)”, Medicare has not listed these codes as acceptable. Those codes include:

  • 11 – Subluxation complex (vertebral) of cervical region
  • 13 – Subluxation complex (vertebral) of lumbar region

“S” injury codes in Chapter 19 of ICD-10-CM include the exact term described by chiropractors. More appealing codes are from “S” injury:

  • 1- for cervical subluxations
  • 1- for thoracic subluxations
  • 1- for lumbar subluxations (with the sixth character “0”)

However, these codes may not be the best option for several reasons such as:

  • There are matches for the 839 category that are not payable by Medicare
  • The entire chapter is for acute injuries and it also include sprains and other serious traumatic conditions
  • Chiropractors must document a specific interspace to explain which bone is dislocated to use this code
  • No subluxation codes for L5/S1 or the sacroiliac joints that are typically treated by chiropractors and a seventh character is required to assign the episode of care.

Though these injury codes are not really ideal for the subluxation defined by specialists, it works just fine if you are trying to describe a dislocation. For a perfect claim, it is crucial that the documentation matches the diagnosis codes selected. As confusion exists, it would be better to check with specific payers before using these codes to justify the treatment. Let the payers know that you are using the codes they prefer.

Meghann Drella

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.

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