2017 ICD10 Updates

As occurs every October 1 there are additions and deletions to the ICD10 code set. Note also there is an update in the document library for the updated ABN for Medicare.

This year is no different though the codes updating that relate to chiropractic claims are very small, compared to the 100+ for last year. The only common code that updated is lumbar spinal stenosis that now differentiates to indicate with or without neurogenic claudication.

This list compromises the codes most likely to affect chiropractic claims. As always The Digital Coding site allows you to search for updates via a key word search 0-1-2017 for this year (note last year’s changes can be viewed with a search of 10-1-2016 and are included in this list also)

Note the codes in bold will be deleted after 10-1-2017 or 10-1-2016 Note the date of service will determine the code. Visits on or after 10-1 of each year require the updated codes.

 October 1, 2017 additions & deletions

  • M48.06 Spinal stenosis, lumbar region (deleted 10-1-2016)
  • M48.061 Spinal stenosis, lumbar region without neurogenic claudication
  • M48.062 Spinal stenosis, lumbar region with neurogenic claudication
  • Z68.1   Body mass index (BMI) 19.9 or less, adult
  • Z71.82   Exercise counseling
  • G12.25 Progressive spinal muscle atrophy

October 1, 2016 additions & deletions

  • 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
  • M26.60  Temporomandibular joint disorder, unspecified (deleted 10-1-2016)
  • 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
  • M26.61  Adhesions and ankylosis of temporomandibular joint (deleted 10-1-2016)
  • 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
  • M26.62  Arthralgia of temporomandibular joint (deleted 10-1-2016)
  • 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
  • M26.63  Articular disc disorder of temporomandibular joint (deleted 10-1-2016)
  • 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
  • M50.20 Cervical disc disorder C4-5, C5-6 , C6-7 region (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
  • M50.12 Mid-cervical disc disorder C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • 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
  • M50.22 Other cervical disc displacement C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • 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
  • M50.32 Other cervical disc degeneration C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • 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
  • M50.82 Other cervical disc disorders C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • 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
  • M50.92 Unspecified cervical disc disorder C4-5, C5-6 , C6-7 region (deleted 10-1-2016)
  • 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
  • S03.4XXA  Sprain of jaw, initial encounter (deleted 10-1-2016)
  • S03.4XXD  Sprain of jaw, subsequent encounter (deleted 10-1-2016)
  • S03.4XXS  Sprain of jaw, sequela (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
  • S03.42XS Sprain of jaw, left side, sequela
  • S03.43XA Sprain of jaw, bilateral, initial encounter
  • S03.43XD Sprain of jaw, bilateral, subsequent encounter
  • S03.43XS Sprain of jaw, bilateral, sequela
  • Z98.89  Other specified postprocedural states (deleted 10-1-2016)
  • Z98.890 Other specified postprocedural states

Medicare 2017

Medicare deductible for 2017 has been published and will go up to $183. The 2016 deductible was $166.

Medicare fees for 2017 are yet to be published, but once finalized we will notify all members. Be aware that the fees when first published may update so do not be surprised what they are first published that is not later amended fee schedule before January 1, 2017.

Quality Payment Program (Medicare Access and CHIP Reauthorization Act (MACRA) MACRA , Merit-based Incentive Performance System MIPS performance reporting similar to PQRS)

First and foremost do not panic or make any rush decisions. This new reporting requirement, for the most part, is the revised phase of PQRS and the chiropractic profession has time to decide in what ways they may choose or not choose to participate and additionally have an exemption. A D.C. has all the way to October 1, 2017, to make a choice of participation and the reporting will potentially result in a bonus payment in 2019. Note this just like the 2 year lag for PQRS reporting it is the same. Note PQRS reductions will still apply for 2017 and 2018 depending on your compliance for that reporting in in 2015 and 2016 respectively

Chiropractors are included in the definition of “physician” under section 1861(r) of the Act, and therefore, are MIPS, eligible clinicians.

Avoiding penalties under MACRA or MIPS just got easier. The Centers for Medicare and Medicaid Services (CMS) announced that the final MACRA regulation will exempt physicians from any risk of penalties if they choose one of three distinct reporting options in 2017

  • Option one: Test the program
    As long as you submit some data to the Quality Payment Program, including data from after Jan. 1, you will avoid a negative payment adjustment. This option is intended to ensure that the system is working and that physicians are prepared for broader participation in the coming years as they learn more.
  • Option two: Partial-year reporting
    Physicians can choose to report Quality Payment Program information for a reduced number of days. Your first performance period could begin well after Jan. 1 and your practice could still qualify for an incentive payment.
    If you submit information for part of the calendar year for quality measures, how your practice uses technology and what improvement activities your practice is undertaking you could qualify for a small positive payment adjustment.
  • Option three: Full-year reporting
    If your practice is ready to get started on Jan. 1, you can choose to report Quality Payment Program information for the full calendar year. Your first performance period would begin on Jan. 1, and if you submit information for the entire year your practice could qualify for a modest positive payment.

Frankly, the full ruling is not clear nor has its final publishing. I would take a precipitous choice but a wait and see as to what protocol may work best for your practice and note the potential exemptions that also may apply before undertaking a reporting that may or may not provide a cost benefit to your office.

As more and clear information becomes available we will keep our members apprised. All the information will be also provided to at our continuing education seminars.

 

ICD10 Updates for Medicare

Medicare, as expected, has now released their updated ICD10 code lists for chiropractic. The updates will affect coding in most states. Your digital coding subscription gives you immediate access to these updates. Once logged in simply go to the Medicare section, choose your state and the current list will be revealed. Remember sending a deleted or a code that is not on the Medicare list will result in an automatic denial of your Medicare claim.

The affected codes are cervical disc which provides 24 new codes and the deletion of 4.

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.

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Proper Use of Unspecified and Other Codes in ICD10

 

I am confused when it comes to using codes that state unspecified. I see there are three codes for extremity pain codes. There is a code for right, left and unspecified. I have heard from some that I should never use the code unspecified, is that correct?
With the plethora of new codes available in ICD10, some of the language can be overwhelming or at best confusing to decipher. In fact, that statement is partially true. Indeed it is not likely you would ever use a code for an unspecified shoulder. However, let’s make a clarification of this meaning. M25.519 indicates pain in the unspecified shoulder, while M25.511 is pain in the right shoulder and M25.512 is pain in the right shoulder. When you physically examine the patient it would be clear that you could identify the pain being right, left or both shoulders. Therefore it would not be appropriate to indicate unspecified shoulder as you can identify if it is right, left or both. When bilateral simply use both codes. Unspecified when it comes to identifying an extremity as left or right would not appropriate assuming you physically see the patient and can identify it as left or right.

Please note do not infer that unspecified may or does mean both or bilateral. If both shoulders have pain the claim would indicate both the right and left codes. For pain in the extremities, there is no code that indicates bilateral and therefore when right and left are involved both codes would be utilized. Unspecified shoulder would likely only be used in a setting such as a hospital where emergency personnel contact the hospital indicating a shoulder injury and the initial documentation of the diagnosis would be unspecified until the person is examined.
However, there are many codes that indicate unspecified or other and are not referring to left, right or location. When using codes that state “other” or “unspecified” note these have special meanings. Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist. One obvious example is muscle spasm. There are three codes that indicate muscle spasm, muscle spasm of the back is M62.830 and muscle spasm of the calf is M62.831 which are specific to those 2 regions. But third code is M62.838 other muscle spasm. The “other” code, therefore, would be chosen when the spasm is not in the back or the calf but some “other” region.
Another example would be a patient where the history and exam findings lead you to a diagnosis of facet syndrome. When you search there is no specific code that states “facet syndrome.” In this case, you would use the codes M53.80 to M53.88 which are noted as “other specified dorsopathies” these codes defines and extends from the occipito-atlanto-axial region to the sacral and sacrococcygeal region.
This would be the proper code to use when specifying the condition as “facet syndrome” and therefore fits as “other specified dorsopathies.” This type of code is used when you can indicate or describe the specific diagnosis or causation of condition but there is no code that indicates that specific diagnosis directly.

In opposition when the pain or dorsopathy is determined as sciatica, you can indicate M54.31 to M54.32 for sciatic pain or M54.41 to M54.42 for lumbago with sciatic pain as there are codes that specifically indicate the diagnosis for sciatica or low back with sciatica.

Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. This means you have a patient with a dorsopathy (back pathology or pain) but cannot clearly determine a specific diagnosis or causation and therefore would use the code M53.9 which is for “dorsopathy unspecified” as there is no clear diagnostic conclusion.

Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. This, in reality, takes the place when a provider has several potential diagnostic possibilities or suspicions and is wanting g to use a “rule out diagnosis.” For instance, a patient presents with lower back pain that is severe and the provider is suspicious it may be a disc pathology. However, until a proper scan or another test can provide conclusive evidence of a disc pathology the diagnosis will initiate as lower back pain (lumbago) M54.5. Once there is confirmation of the disc pathology then the disc codes may be utilized. Be sure to only code what you can confirm based on your history, physical examination, and testing. This would mean the initial diagnosis may indeed be pain but later be amended to a specific condition once confirmed.

Sign(s)/symptom(s) and “unspecified” codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record 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 healthcare encounter should be coded to the level of certainty known for that encounter. 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.

As confusing as it may seem at first glance ICD10 is simply is a detailed granulated method of description that can be very specific but not always as specific as we may assume and non-specific codes that are “unspecified or other” may be appropriate and the most correct code.

1500 Claim Form clarification and use of Block 24E “Diagnosis Pointer” and Specific Rules for Medicare claims

Many billing programs will automatically default to include the letters corresponding to the diagnosis in block 21. If you have 4 (or more) diagnosis in block 24e it will often simply default to ABCD. Having this protocol as a default should not lead to any problems except in two instances. The first being when attempting to “diagnosis point” to a specific diagnosis or region. For example Manual Therapy, 97140, must be done to a region that is not part of the CMT and a simple way to do this is specifically point only to the diagnosis that corresponds to the separate and distinct region from where 97140 is being performed and pointing the other regions to the CMT.

The instruction manual for the 1500 describes use of 24E in this manner:

In 24E, enter the diagnosis code reference letter (pointer) as shown in Item Number 21 to relate the date of service and the procedures performed to the primary diagnosis. When multiple

services are performed, the primary reference letter for each service should be listed first, other applicable services should follow. The reference letter(s) should be letters A through L or multiple letters as applicable. Each letter must be entered separately. Do not enter A-E or similar but 4 separate letters. Enter letters left justified in the field. Do not use commas between the letters. There may be a maximum of 4 letters listed in 24E any additional are simply not reported in this section.

The second instance is for Medicare claims which allows only one letter in 24E and for chiropractic claims for spinal CMT it will always be “A “as it corresponds to the primary diagnosis of subluxation (segmental dysfunction).

The Medicare claim form instructions states as follows

Item 24E Diagnosis Code Reference Number
This is a required field. Enter the diagnosis code reference number or letter (as appropriate, per form version) as shown in Item 21 to relate the date of service and the procedures performed to the primary diagnosis. Enter only one reference number/letter per line item. When multiple services are performed, enter the primary reference number/letter for each service. This will be a letter from A to L.

 

Medicare will deny claims if you have multiple letters in 24E, if you have noted you have done this in past and Medicare has paid, consider yourself lucky and note they are simply being more strict about adherence to claim form protocols.

Please verify with your billing software that they are aware of this rule and make the necessary corrections to be sure your format is compliant.

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.

New X-Ray Codes for 2016

2016 CPT coding has deleted and added some procedure codes for spinal x-rays.

72010 Full spine AP and Lateral, 72069 Thoracolumbar standing (scoliosis), and 72090 Scoliosis study supine and erect studies have been deleted and have additions of 4 new codes that replace and further delineate specific x-ray studies.

The codes in bold represent the 2016 additions with how they replace the above noted below.

  Spine
72020 Spine, single view, specify level
72040 Cervical spine, 2 or 3 views
72050 Cervical spine, minimum 4 or 5 views
72052 Cervical spine, 6 or more views
72070 Thoracic spine, 2 views
72072 Thoracic spine 3 views
72074 Thoracic spine, 4 views
72080 Thoracolumbar junction, minimum 2 views
72081 Spine entire thoracic and lumbar including skull and sacral spine 1 view
72082 Spine entire thoracic and lumbar including skull and sacral spine 2-3 views
72083 Spine entire thoracic and lumbar including skull and sacral spine 4-5 views
72084 Spine entire thoracic and lumbar including skull and sacral spine 6 views
72100 Lumbosacral spine, 2 or 3 views
72110 Lumbosacral spine, minimum 4 views
72114 Lumbosacral spine, minimum 6 views
72120 Lumbosacral spine, bending only 2 or 3 views

 

72010 Full spine AP and Lateral has been deleted use 72082

For a single view that includes the entire thoracic and lumbar spine use 72081

72069 Thoracolumbar standing (scoliosis) has been deleted. To report use 72081, 72082 72083 or 72084

72090 Scoliosis study supine and erect studies has been deleted use 72081, 72082, 72083, 72084

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