ICD-10 - Good or Bad for the Chiropractic Profession?
DOCUMENTATION
Jill Foote
ACA Sr. Mgr. Coding
& Practice Mgmt
It’s about 6:00 p.m. on a Friday. You’re about to wrap up a long and busy day of treating patients. As you reflect upon the individuals that entered your office and walked out feeling better as a result of their treatment, a smile appears on your face.
There was Mr. Smith, who came to your office bent over and unable to stand up straight. He twisted his upper back and sprained his lower back while trying to prevent a fall from a ladder at home. Then there was Mr. Right, who shoveled snow over the weekend. He complained of low-back pain and sciatica in his left leg. This was clearly a new symptom since he had only reported right-leg symptoms in the past. As you
wrap up your chart entries, you think, “Wouldn’t it be nice if payers knew how much I had helped these patients?” If only they knew just how complicated each case was and the exact type and number of conditions that each patient had suffered.
Before the transition to ICD-10-CM, a chiropractic physician’s story was limited to a code set that was inadequate in details, lacked laterality, and was full of unspecified conditions. Now, with ICD-10, doctors of chiropractic (DCs) can finally tell the full story.
^ ^Doctor can simply turn the pages of the tabular list within an ICD-10 coding manual to find the code that best describes the patient’s condition. 5 5
For example, under, Mr. Smith’s case more than likely would have been diagnosed as 847.2 “lumbar sprain/strain.” Yet with ICD-10, a provider can now report a sprain separate from a strain. For 30 years, DCs could not report the sprain of a ligament as a stand-alone code. As a result, this virtually avascular bundle of dense fibrous connective tissue that often requires longer healing time was lost in a vague ICD-9 combination code description. In Mr. Smith’s case, the provider can now report “sprain of ligaments of lumbar spine” (S33.5xx_), and the cause, “falling off ladder” (Wll.XXXA). Finally, a provider can report the complete story for a patient.
Prior to ICD-10, studies on the amount of rehabilitation and the time needed for full recovery after a sprain injury versus a strain injury were limited. This was due to the inability to report these conditions separately in ICD-9. The importance of understanding and reporting strains and sprains separately enables stakeholders and researchers to understand how often these injuries are treated in a chiropractic setting. It also shows how evidence-based chiropractic treatment contributes to improving the condition of the injured area and restoring its function.
As for Mr. Right, under ICD-9 the provider would more than likely have diagnosed this case as 724.3, “sciatica.” A payer could easily assume that this was a chronic condition that had reached maximum medical improvement. Yet with ICD-10, a provider can now report laterality with sciatica and communicate to the payer that the patient (in this case, Mr. Right) was experiencing a new symptom. This diagnosis, with supporting documentation, would reinforce the need and the medical necessity for a new treatment plan. Once again, the ability to tell the complete story is now at the doctor’s fingertips. A doctor can simply turn the pages of the tabular list within an ICD-10 coding manual to find the code that best describes the patient’s condition.
The expanded code list of ICD-10 provides ample opportunity for DCs to fully report the patient’s condition and provide substantial proof of the effectiveness of chiropractic care for a variety of conditions. For example, ICD-9 only allowed
the provider to report “myalgia and myositis unspecified” (729.1), and did not offer a code for a common condition such as fibromyalgia. Now ICD-10 offers separate codes for “other myositis” at multiple sites (M60.80-M60.9); “myalgia” (M79.1); and “fibromyalgia” (M79.7).
Where ICD-9 provided one diagnosis (724.4) to report “thoracic or lumbosacral neuritis or radiculitis, unspecified,” ICD-10 now offers the following separate and distinct regions: “radiculopathy, thoracic region” (M54.14); “radiculopathy, thoracolumbar region” (M54.15); “radiculopathy, lumbar region” (M54.16); and “radiculopathy, lumbosacral region” (M54.17).
Prior to ICD-10, acquired spondylolisthesis was reported with the single ICD-9 code, 738.4. Now a doctor can specify the exact region, such as cervical region (M43.12) separate from lumbar region (M43.16). This makes it possible to communicate to the payer the need for multiple levels of chiropractic manipulative treatment (CMT) or regions of therapy.
The new ICD-10 codes enable the doctor to report new conditions that in the past would have been considered the same condition due to lack of specificity within the ICD-9 code set. This list includes:
• A separation of subluxation from dislocation
• Disc disorder listed not only by region but separated by highand mid-level
• Low-back pain with or without sciatica
• Limb pain now separated into more than 20 distinct codes
• Sprain of shoulder listed as left and right and separate from sprain of rotator cuff
It may be too early to tell for sure what impact ICD-10 will have on the chiropractic profession overall. Yet, we can be confident that the data collected could result in enhanced coverage and improved understanding of the value of the services provided by chiropractic physicians within the healthcare system. As DCs begin to report these conditions by selecting specific diagnoses and providing supporting documentation, a book of evidence-based care is being written, which makes proper code selection crucial. For the first time in more than 30 years, chiropractic physicians now have a comprehensive coding resource to tell their story. That, undoubtedly, is good for the chiropractic profession.
tJiU Foote is senior manager in coding andpractice management for the American Chiropractic Association (ACA) in Arlington, Virginia. She had over thirteen years of chiropractic clinic experience in billing and practice management prior to joining the ACA ’s staff in 2013. In her current position at ACA, she has sewed as staff liaison to the AC A’s Coding Manual Workgroup and ICD-10 Taskforce, and currently sewes as staff liaison to the Coding Committee, coordinating the association ’s coding initiatives and educational campaigns. She can be reached at [email protected].
