The Head Bone’s Connected to the Neck Bone: The CA, ICD-10, and Basic Anatomy
Kathy Mills Chang
Many chiropractic assistants—and more than a few DCs—are feeling overwhelmed by ICD-10. It is, after all, the beginning of a new area of chiropractic documentation and billing. However, there's an opportunity here that CAs might be missing. ICD-10 offers chiropractic assistants the chance to raise their game in a significant, measurable, and meaningful way.
CAs can't perform an exam, diagnose, or adjust, but they can and do handle just about everything else! The more chiropractic assistants educate themselves, the greater the support they're able to give the doctor and the rest of the practice's team. One of the best and most timely ways to do that is to focus on the basics of medical terminology, chiropractic terminology, basic anatomy, and even to some degree, basic physiology.
The "why" is all in the transition. ICD-9 is making way for ICD-10 precisely because it lacks the specificity and laterality documentation needs to supply. With ICD-10's increased precision, chiropractic assistants will need to be able to read the doctor's documentation and understand exactly what's going on. Better yet, the well-informed CA will be able to double-check documentation to make sure the codes match the treatment.
If you don't already, you'll need to learn the regions of the spine, the terminology of laterality (the different sides of the body), the stages of healing, and more. It's fine to understand that ICD-10 codes have seven digits instead of the five we've been used to seeing. However, knowing that those extra digits are there to document in even greater detail underscores the need for you to dig deep and step up.
Consider starting by pulling out your documentation templates and reviewing the systems and areas of the body as well as the elements of the exam. Spend some time with your doctors so you can understand what body systems are involved in testing and in the routine examination procedures in your office. Go in with your doctor and take some notes so you can learn what part of the body is being treated and why.
See, everything your office bills to a third-party carrier must be supported in the documentation. If you're the one submitting the billing, then you should be able to determine if the codes on the claim appearto be supported by documentation, correctly reflect the encounter, and are free from error.
“lCD-10 offers chiropractic assistants the chance to raise their game in a significant, measurable, and meaningful way. ”
Feeling overwhelmed? Think back to when you learned vocabulary in elementary school—or maybe a second language further along in school. It all starts with root phrases. Once you learn the roots, you're well on your way to understanding what an unknown term actually means. Medical terminology has Greek and Latin origins.
“You don't have to speak either one, but it will pay off big-time if you take the time now to familiarize yourself with their roots before ICD-10 hits. ”
You don't have to speak either one, but it will pay off bigtime if you take the time now to familiarize yourself with their roots before ICD-10 hits.
As an example, let's consider "intractable migraine with aura." You probably already know what a migraine is (and if that's from personal experience, you have our sympathies). You probably know what an aura (vision changes) is in regards to migraines too. What you might not know, though, is that there's one ICD-10 code for migraine, and a separate one for migraine with aura. You'd need to check the documentation if you saw one of these codes to determine if the patient's history supports this code choice.
And how about that word "intractable?" If you remember English class, you may already know that "in" means "none," or "nothing." The rest of the word means "helping or getting over." Put those together, and you have a condition that nothing has helped get better.
You may also see the diagnosis appended with "status migrainosus." "Osus" means "a process or condition." That means the migraine has gone from a simple one-time migraine to a condition. The status "migrainosus" is applied when the migraine lasts longer than 72 hours, and that would need to be supported in the history section of the documentation.
That is just one example, but those phrases and their roots will appear over and over in notes, patient history, and documentation, as will many others. Whether you choose to learn by observation, brute memorization, or a combination of the two, it's time to get started. ICD-10 will be chiropractic's new coding language as of October 1. Make sure you're fluent.
Kathy Mills Chang is a certified medical compliance specialist (MCS-P) and certified chiropractic professional coder (CCPC). Since 1983, she’s been providing chiropractors with reimbursement and compliance training, analysis, and tools to help practices increase revenue and decrease risk. Kathy leads a team of 16 at KMC University, and is known as one of our profession ’s foremost experts on Medicare. She or any of her team members can be reached at 855-832-6562, at http://kmcuniversity.com, or by sending an e-mail to [email protected].
