Category Archives: Uncategorized

2019 Medicare Update

2019 Medicare Update

Medicare deductible for 2019 will be $185 (a $2 increase from 2018). Chiropractic providers have an exemption for MIPS and MACRA reporting if they have less than 200 Medicare patients or less than $90k of revenue from Medicare. This means no reductions for nonuse of EHR and functional outcomes.

When billing for physical medicine services, though excluded for payment by Medicare, you must include modifier GP to indicate a physical medicine care plan as well as GY. By example 9701 GP GY and note the order of the modifiers does not matter.

New ICD-10 Codes for Chiropractic Effective 10-1-2016

The following codes are being added 10-1-2016. This list compromises the most likely to affect a chiropractic claims. For chiropractic the likely most common codes that have been added are cervical spine disc disorder, disc degeneration and disc displacement along with TMJ, jaw and added bilateral codes for carpal tunnel and nerve lesions for the extremities.

The new codes are now in Digital COding and can be searched by “10-1-2016” in the search bar and it will be bring up all the new, updated and deleted codes.

Note the date of service will determine the code. Visits on or after 10-1-2016 require the updated codes.


  • E78.0  Pure hypercholesterolemia(deleted 10-1-2016)
  • E78.00 Pure hypercholesterolemia, unspecified
  • E78.01 Familial hypercholesterolemia
  • F32.81 Premenstrual dysphoric disorder
  • F32.89 Other specified depressive episodes
  • F34.81 Disruptive mood dysregulation disorder
  • F34.89 Other specified persistent mood disorders
  • F42  Obsessive-compulsive disorder(deleted 10-1-2016)
  • F42.2 Mixed obsessional thoughts and acts
  • F42.3 Hoarding disorder
  • F42.4 Excoriation (skin-picking) disorder
  • F42.8 Other obsessive-compulsive disorder
  • F42.9 Obsessive-compulsive disorder, unspecified
  • F50.8  Other eating disorders(deleted 10-1-2016)
  • F50.81 Binge eating disorder
  • F50.89 Other specified eating disorder
  • G56.03 Carpal tunnel syndrome, bilateral upper limbs
  • G56.13 Other lesions of median nerve, bilateral upper limbs
  • G56.23 Lesion of ulnar nerve, bilateral upper limbs
  • G56.33 Lesion of radial nerve, bilateral upper limbs
  • G56.43 Causalgia of bilateral upper limbs
  • G56.83 Other specified mononeuropathies of bilateral upper limbs
  • G56.93 Unspecified mononeuropathy of bilateral upper limbs
  • G57.03 Lesion of sciatic nerve, bilateral lower limbs
  • G57.13 Meralgia paresthetica, bilateral lower limbs
  • G57.23 Lesion of femoral nerve, bilateral lower limbs
  • G57.33 Lesion of lateral popliteal nerve, bilateral lower limbs
  • G57.43 Lesion of medial popliteal nerve, bilateral lower limbs
  • G57.53 Tarsal tunnel syndrome, bilateral lower limbs
  • G57.63 Lesion of plantar nerve, bilateral lower limbs
  • G57.73 Causalgia of bilateral lower limbs
  • G57.83 Other specified mononeuropathies of bilateral lower limbs
  • G57.93 Unspecified mononeuropathy of bilateral lower limbs
  • H93.A1 Pulsatile tinnitus, right ear
  • H93.A2 Pulsatile tinnitus, left ear
  • H93.A3 Pulsatile tinnitus, bilateral
  • H93.A9 Pulsatile tinnitus, unspecified ear
  • K52.29 Other allergic and dietetic gastroenteritis and colitis
  • K52.2  Allergic and dietetic gastroenteritis and colitis (deleted 10-1-2016)
  • K52.3 Indeterminate colitis
  • K52.831 Collagenous colitis
  • K52.832 Lymphocytic colitis
  • K52.838 Other microscopic colitis
  • K52.839 Microscopic colitis, unspecified
  • K90.41 Non-celiac gluten sensitivity
  • 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
  • M25.541 Pain in joints of right hand
  • M25.542 Pain in joints of left hand
  • M25.549 Pain in joints of unspecified hand
  • M26.601 Right temporomandibular joint disorder, unspecified
  • M26.602 Left temporomandibular joint disorder, unspecified
  • M26.603 Bilateral temporomandibular joint disorder, unspecified
  • M26.609 Unspecified temporomandibular joint disorder, unspecified side
  • M26.611 Adhesions and ankylosis of right temporomandibular joint
  • M26.612 Adhesions and ankylosis of left temporomandibular joint
  • M26.613 Adhesions and ankylosis of bilateral temporomandibular joint
  • M26.619 Adhesions and ankylosis of temporomandibular joint, unspecified side
  • M26.621 Arthralgia of right temporomandibular joint
  • M26.622 Arthralgia of left temporomandibular joint
  • M26.623 Arthralgia of bilateral temporomandibular joint
  • M26.629 Arthralgia of temporomandibular joint, unspecified side
  • M26.631 Articular disc disorder of right temporomandibular joint
  • M26.632 Articular disc disorder of left temporomandibular joint
  • M26.633 Articular disc disorder of bilateral temporomandibular joint
  • M26.639 Articular disc disorder of temporomandibular joint, unspecified side
  • M26.60  Temporomandibular joint disorder, unspecified (deleted 10-1-2016)
  • M26.61  Adhesions and ankylosis of temporomandibular joint (deleted 10-1-2016)
  • M26.62  Arthralgia of temporomandibular joint (deleted 10-1-2016)
  • M26.63  Articular disc disorder of temporomandibular joint (deleted 10-1-2016)
  • M50.020 Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
  • M50.021 Cervical disc disorder at C4-C5 level with myelopathy
  • M50.022 Cervical disc disorder at C5-C6 level with myelopathy
  • M50.023 Cervical disc disorder at C6-C7 level with myelopathy
  • M50.120 Mid-cervical disc disorder, unspecified
  • 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
  • M50.220 Other cervical disc displacement, mid-cervical region, unspecified level
  • M50.221 Other cervical disc displacement at C4-C5 level
  • M50.222 Other cervical disc displacement at C5-C6 level
  • M50.223 Other cervical disc displacement at C6-C7 level
  • M50.320 Other cervical disc degeneration, mid-cervical region, unspecified level
  • M50.321 Other cervical disc degeneration at C4-C5 level
  • M50.322 Other cervical disc degeneration at C5-C6 level
  • M50.323 Other cervical disc degeneration at C6-C7 level
  • M50.820 Other cervical disc disorders, mid-cervical region, unspecified level
  • M50.821 Other cervical disc disorders at C4-C5 level
  • M50.822 Other cervical disc disorders at C5-C6 level
  • M50.823 Other cervical disc disorders at C6-C7 level
  • M50.920 Unspecified cervical disc disorder, mid-cervical region, unspecified level
  • M50.921 Unspecified cervical disc disorder at C4-C5 level
  • M50.922 Unspecified cervical disc disorder at C5-C6 level
  • M50.923 Unspecified cervical disc disorder at C6-C7 level
  • N50.811 Right testicular pain
  • N50.812 Left testicular pain
  • N50.819 Testicular pain, unspecified
  • N50.82 Scrotal pain
  • N50.89 Other specified disorders of the male genital organs
  • N50.8  Other specified disorders of male genital organs(deleted 10-1-2016)
  • N94.10 Unspecified dyspareunia
  • N94.11 Superficial (introital) dyspareunia
  • N94.12 Deep dyspareunia
  • N94.19 Other specified dyspareunia
  • N94.1  Dyspareunia(deleted 10-1-2016)
  • S03.40XA Sprain of jaw, unspecified side, initial encounter
  • S03.40XD Sprain of jaw, unspecified side, subsequent encounter
  • S03.40XS Sprain of jaw, unspecified side, sequela
  • S03.41XA Sprain of jaw, right side, initial encounter
  • S03.41XD Sprain of jaw, right side, subsequent encounter
  • S03.41XS Sprain of jaw, right side, sequela
  • S03.42XA Sprain of jaw, left side, initial encounter
  • S03.42XD Sprain of jaw, left side, subsequent encounter

New ICD-10 Codes Headed Your Way on 10-1-2016

“It is critical to stay abreast of changes in coding and payer billing guidelines related to coding…maintaining current knowledge is imperative for the long-term survival and safety of  a practice.”

This statement is how the AMA instructs their members to prosper… and we agree.  There are numerous new, revised and deleted codes to ICD10 that will implement on 10-1-2016.

Most printed publications will not have included these updates in 2016 print editions which means your Digital Coding membership continues to be the most up-to-date and accurate resource.

Here's what you need to know:

  • ICD10 Codes will update on 10-1-2016 and dates of service on or after 10-1-2016 must use the updated codes
  • With your active Digital Coding subscription you can access all these new codes instantaneously simply by logging in and searching: 10-1-2016
  • Your search will yield over 100 results of new and updated codes that are chiropractic specific and MUST be used on or after 10-1-2016.
  • 40 codes have been deleted and replaced with new codes that offer more specificity.
  • Beyond the new codes specific to chiropractic there will be a list of all new, updated and deleted codes published on the site as well.
  • Medicare diagnosis will also be updated and note Florida Medicare is updating on September 12, 2016.

If you've let your account lapse, just SIGN-UP HERE to get instant access to the entire Digital Coding site.

Want to see something on Digital Coding that would thrive? We prize your feedback and always welcome to hear from you.


Noridian Medicare Diagnosis Update Chiropractic Services LCD – R3

There has been an update to the Medicare LCD for Noridian

This includes Jurisdiction E - California, Hawaii, Nevada, American Samoa, Guam & Northern Mariana Islands.

Jurisdiction F - Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah Washington, & Wyoming

Category II has had the addition of the following strain or sprain codes which may now be used for Medicare secondary codes. These additions are reflected in the HJ Ross Digital Coding site as well.

S13.4XXD, S13.4XXS, S13.8XXD, S13.8XXS, S16.1XXD, S16.1XXS, S23.3XXD, S23.3XXS, S23.8XXD, S23.8XXS, S33.5XXD, S33.5XXS, S33.6XXD, S33.6XXS, S33.8XXD, S33.8XXS, S39.012A, S39.012D, S39.012S.

ICD10 Updates and News

CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally. Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment.  Based on the metrics comparing ICD9 and ICD10 there are lesser claims denied due to invalid coding with ICD10 when compared to ICD9. So far so god, though Noridian for California and Nevada were denying all claims for chiropractic initially they have corrected their error and have reprocessed all previously denied claims.


Metrics October 1-27 Historical Baseline*
Total Claims Submitted 4.6 million per day 4.6 million per day
Total Claims Rejected due to  incomplete or invalid information 2.0% of total claims submitted 2.0% of total claims submitted
Total Claims Rejected due to invalid ICD-10 codes 0.09% of total claims submitted 0.17% of total claims submitted
Total  Claims Rejected due to invalid ICD-9 codes 0.11% of total claims submitted 0.17% of total claims submitted
Total Claims Denied 10.1% of total claims processed 10% of total claims processed



Aetna has reported they not currently experiencing any issues with processing ICD-10 claims. Other carriers have so far made no formal announcement but we have not had reports of carriers with any problems or issues with ICD10 processing.


Be aware that workers’ compensation claims and personal injury can be exempt from use and does vary from state to state as well as by carrier. The following is a breakdown of what states are using ICD10 and the others who are using ICD9 as well as personal injury carriers.


For workers’ compensation, twenty-one states have adopted ICD-10 billing for physicians, hospital inpatients and outpatients, according to WEDI.

They are: Alabama, California, Florida, Georgia, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, South Dakota, Texas and Washington.

Three states have adopted ICD-10 codes for hospital inpatient billing only: Indiana, Maine and South Carolina.

This leaves 26 states that have no plans for adopting ICD-10 for workers comp claims, unless there's a pending ICD-10 regulation: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Wisconsin and Wyoming.

Personal injury verify with each carrier prior to billing but the following providers have indicated their use of ICD10

  • State Farm Insurance: Will transition to ICD-10 on 10/01/2015. All claims submitted with ICD-10 will be processed accordingly. Additionally, State Farm will continue to process as usual, all claims submitted with ICD-9 diagnoses for an indefinite period of time.
  • American Family Insurance: American Family Insurance is prepared to accept ICD-10 effective 10/01/2015. American Family Insurance will also continue to accept and process claims with ICD-9 diagnoses for an undetermined, but, limited time after 10/1/2015.
  • Progressive Insurance: Progressive Insurance will be transitioning to ICD-10 on the mandated date of 10/01/2015. Claims submit with ICD-9 will be rejected. Providers will receive remittance explaining the rejection and requiring providers to resubmit the claim using ICD-10 diagnosis.
  • GEICO:  Will begin accepting ICD10 codes on 10/1/15.  Bills with a date of service on or after 10/1/15 must contain a valid ICD10 code.  For a date of service prior to 10/1/15 use only valid ICD9 codes. ICD9 and ICD10 codes cannot be combined on a bill.
  • Farmers: Accepting ICD10
  • Nationwide: Accepting ICD10.
  • Safe Co: Accepting ICD10
  • Travelers: Accepting ICD10
  • AAA: Accepting ICD10
  • Allstate & USAA:  No confirmation

Noridian Update 10-28-2015

Noridian Medicare has updated their LCD for chiropractic and has also corrected the error for denied claims in Jurisdiction E (California and Nevada)

The site has been updated to reflect the changes.

There was an addition of codes M43.01 to M43.09 for spondylolysis, M50.91 unspecified disc disorder high cervical and M60.89 other myositis multiple regions

Noridian ICD-10 Update 10-27-2015

The Network has received information from several offices that they have received their first payments on the improperly denied claims by Noridian Medicare Jurisdiction E. Medicare has not officially published any notice but with these payments being reported it a appears to be corrected and back on track.

HIPAA Compliance Audits on the Horison

Recently the Office of Inspector General (OIG) for the Dept of Health and Human Services (HHS) did a study and found that the Office of Civil Rights (OCR), which has responsibility for HIPAA compliance, is not doing enough to ensure covered entities (CEs), including healthcare providers and insurers, are effectively following HIPAA requirements. They found that most activities were reactive, not proactive. The OCR agreed with report's recommendations and that they need to do more oversight actvities.

Look for more HIPAA compliance audits and enforcement activities in the coming months as funding for these activities is provided to the OCR.

Have you gotten all your compliance requirements met? This includes: establishing your policies and procedures; implementing them within your practice; ensuring everyone has taken training; ensuring all your business associates have signed a BA Agreement and have security controls in place; and performing a risk assessment; just to name the major requirements.

Make plans in the near term to address all HIPAA compliance requirements.

NOTE: All the 50 State Attorneys General office are also ramping up to do their own HIPAA compliance audits and enforcement, in addition to the OCR's activities.
See the full report at

Noridian ICD-10 Update

10/19/2015 Update:

Noridian Medicare Part B for Jurisdiction E which are for the states of CA, HI, NV, American Samoa, Guam and Northern Mariana Islands has an error that they are incorrectly denying chiropractic. The LCD is being updated to contain the appropriate diagnosis codes. Once complete, Noridian will identify the claims denied incorrectly and adjust them. No action is required on the provider end at this time. These denials all indicated CO50 = medical necessity

This has not affected other states managed by Medicare or specifically Jurisdiction F Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah Washington and Wyoming.

With a wealth of information at your disposal included in your Digital Coding subscription, we have complied an extended demonstration on how to navigate each portal and use the tools available to members with ease.

In this how-to video meet HJ Ross' principal coding expert, Dr. Sam Collins, and take a tour of the only online chiropractic specific coding & billing resource of its kind.

video demo button