Know the Latest Chiropractic Coding Guidelines

Understanding Chiropractic coding and performing them accurately is a muscle straining job! But the result after better performance is obviously a soothing experience. Faster reimbursements and better coding process happens only if Chiropractic codes are entered appropriately and accurately to specific procedures.

Having good knowledge in patient’s insurance coverage is one of the best ways to interpret healthcare professionals’ necessities and retrieve revenue payments for the services rendered. Chiropractic coding is maintained and published by American Medical Association and these CPT codes are very essential for Chiropractors to follow and get familiar with.

Related Services : Chiropractic Billing Services

Each CPT codes in Chiropractic coding contains five alpha numeric characters that are used to explain and describe evaluation and management services, diagnostic tests, and procedures performed by healthcare professionals or Chiropractors. The code set is larger than to imagine and contains thousands of medical procedures.

As known, every year ICD-10 coding changes take place and for 2021, there are 72616 ICD-10 codes that includes 490 additions, 58 deleted codes and 47 revised codes. The significant ICD-10 updates in Chiropractic coding are the new headache codes, new temporomandibular joint (TMJ) condition codes and codes for micro-mobility devices involving accidents.

Let’s have a look at new Chiropractic coding updates:

New Headache Codes:

The code R51 is non-billable and new for headache and is expanded with two code specifications.

  1. R51.0 : This code is for Headache with orthostatic component, not classified elsewhere.
  2. R51.9 : Headache, unspecified.
  • An Orthostatic headache is considered to be very positional that worsens and causes lot of pain when a person stands.
  • The symptom code R51 is used when the cause for headache is not clearly stated or clarified properly and not clearly diagnosed.
  • The above code is added particularly to distinguish between several other codes intracranial hypotension and cerebrospinal fluid leaks, describes Dynamic Chiropractic in a report.
  • If the cause for the headache is not found and not clarified, use the unspecified code R51.9 in the report.

New Temporomandibular Joint (TMJ) :

  • The Temporomandibular dysfunction is a stage where temporomandibular joints are severely affected or surrounding masticatory musculature is to be treated along.
  • Usually, temporomandibular and muscle disorders are classified by pain and dysfunction in the joint of the jaw and muscles controlling the jaw movement.
  • In Chiropractic coding, codes M26.601 is used for Right temporomandibular joint disorder, unspecified.
  • M26.602 code is used for Left temporomandibular joint disorder, unspecified.
  • M26.603 code is used for Bilateral temporomandibular joint disorder, unspecified, and codes related to M26.621 Arthralgia of right temporomandibular joint.
  • Few more ICD-10 codes for Temporomandibular Joint conditions that especially involves arthritis and arthropathy are :
  1. M26.641 : This code is used for Arthritis of right temporomandibular joint
  2. M26.642 : This code is used for Arthritis of left temporomandibular joint
  3. M26.643 : This code is used for Arthritis of bilateral temporomandibular joint
  4. M26.649 : This code is for Arthritis of unspecified temporomandibular joint
  5. M26.651 : This code is used for Arthropathy of right temporomandibular joint
  6. M26.652 : This code is used for Arthropathy of left temporomandibular joint
  7. M26.653 : This code is for Arthropathy of bilateral temporomandibular joint
  8. M26.659: This code is used for Arthropathy of unspecified temporomandibular joint.

New codes for Accidents Involving Micro-Mobility Devices:

  • Almost 123 new codes are being involved to report accidents involving Micro-Mobility Devices like hover boards, electric bikes, segways. These are termed as External Cause Codes and are essential claiming insurance for accidents.

Other Chiropractic coding updates:

  • In Chiropractic coding, Osteochondrosis is a typical situation where the bone growth is not in an order developing growth plate and more of the surrounding ossification centers i.e., epiphyses that occurs primarily in children caused by a variety of factors.
  • Those factors include genetics, injury, repetitive trauma or overuse, vascular abnormalities, mechanical factors, hormonal imbalances.
  • It’s also mainly characterized by necrosis along with revascularization, regeneration, and recalcification. Symptoms are, discomfort, pain, and even disability.
  • The sub-categories added for osteochondrosis, and a set of disorders that affect bone growth in children and adolescents are:
  1. M92.50 : This code is for Unspecified juvenile osteochondrosis
  2. M92.51: This code is for Juvenile osteochondrosis of proximal tibia
  3. M92.52: This code is used for Juvenile osteochondrosis of tibia tubercle
  4. M92.59: This code is specified for other juvenile osteochondrosis of tibia and fibula.

Other Specifies Joint additions in Chiropractic coding:

  • The new codes under sub categories those include options to report other specified site. The codes are given below:
  1. M24.19 : This code is for Articular cartilage disorders
  2. M24.29 : This code is for the Disorder of ligament
  3. M19.09, M19.19, M19.29 : This code is used for Osteoarthritis:
  4. M05.7A, M05.8A, M06.0A, M06.8A, M08.0A, M08.2A, M08.4A, and M08.9A: This code is used for Rheumatoid arthritis.
  • The new codes given below also have the option to report other specified joint. They are:
  1. M24.69 – This code is used for Ankylosis
  2. M24.59 – This code is used for Contracture
  3. M24.89 –This code is used for Derangement
  4. M24.39, M24.49 –This code is used for Dislocation
  5. M25.39, M25.59, M25.69 – This code is used for instability, pain, stiffness.
  • ICD-10 coding guidelines for Chiropractic coding are accompanied by several instructions. According to the guidelines, unspecified must be used only if the documentation does not give enough information or complete information to report certain ICD-10 codes and procedures.

October 2021 Coding Update

Effective October 1, 2021, new chiropractic coding practices are in place with one deleted code and 14 new additions. It is important for coders to take note of this change since updating the codes in their workflow is crucial for a clean claim. Make sure you are up to date with the current guidelines to maximize your revenue.

Deleted code: M54.5

The code M54.5 refers to low back pain. The code is no longer valid in a chiropractic practice due to a few reasons. Earlier, low back pain was thought to be a good choice to include in the chiropractic setup. However, investigating the vertebrogenic low back pain often requires deeper diagnostic tests such as an MRI. The diagnosis could also need the evidence of endplate damage, which can only be confirmed after a series of imaging tests are performed on the patient. Therefore, this code has been deleted in the chiropractic context.

Which codes will replace M54.5?

The codes M54.50, M54.51 and M54.59 have replaced the deleted code M54.5 to ensure a more detailed diagnosis and treatment plan for the patient. M54.50 refers to low back pain if it is unspecified. M54.51 refers to vertebrogenic low back pain while M54.59 refers to any other low back pain. The division of codes with respect to low back pain will give a more transparent view into the diagnosis and help the provider with a specified care plan for the patient.

Other New Codes

The other newly added codes refer to the non-radiographic axial spondyloarthritis of different parts of the body. The codes with their specific region are:

  • M45.A0: unspecified sites in the spine
  • M45.A1: Occipito-atlanto-axial region
  • M45.A2: Cervical region
  • M45.A3: Cervicothoracic region
  • M45.A4: Thoracic region
  • M45.A5: Thoracolumbar region
  • M45.A6: Lumbar region
  • M45.A7: Lumbosacral region
  • M45.A8: Sacrococcygeal region
  • M45.AB: Multiple sites in spine

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