The “Short List” of ICD-10 Codes for Chiropractors
FEATURE
Evan M. Gwilliam
No one will know which ICD-10 codes will be used commonly by chiropractors until the code set has been in place for a while and ICD-9 codes are in the rearview mirror once and for all. In the meantime, though, educated guesses can be made using the same resource that payers have in front of them: the Tabular List in the ICD-10-CM code set. Diagnosis codes are reported on claim forms to describe the reason for a healthcare encounter. Third parties use them to determine if the care provided was medically necessary and, therefore, reimbursable. Everyone has become quite comfortable with ICD-9 codes since they have been in use for more than 35 years. When the US healthcare system transitions to ICD-10 on October 1, 2015, it will be helpful to know which codes chiropractors aie most likely to use.
Many chiropractic physicians become discouraged when they leam of the sheer size of the ICD-10 code set. There are nearly five times as many codes, and truthfully, most chiropractors only use between 10 and 20 ICD-9 codes. Therefore, it stands to reason that the commonly used code list for chiropractic may be five times as long, at perhaps 50 to 75 codes. Unfortunately, it is not that simple. For example, chiropractors frequently report diagnoses that pertain to the spine, and the spine is separated into as many as eight regions for several codes in ICD-10:
• Occipito-atlanto-axial region
• Cervical
• Cervicothoracic
• Thoracic
• Thoracolumbar
• Lumbai'
• Lumbosacral
• Sacral and sacrococcygeal
This applies to many diagnoses that only had one or two options in ICD-9, such as spondylosis, spondylolisthesis, and stenosis. These codes all increase at least eightfold.
These examples are pretty easy to understand, and DCs should not be intimidated by the increase in code options because they already know and document this anatomical information. Some codes appear to be a clear one-to-one match, while others have dozens of potential replacements. When examining the ICD-10 options based on other equivalent commonly used ICD-9 codes, some investigation will reveal that a simple list of ICD-10 common codes is elusive. The typical chiropractor may end up with 150 to 250 ICD-10 codes when he or she only used 15 in ICD-9. A list may not properly outline the options, so a decision tree will be necessary.
739 Segmental and Somatic Dysfunction
For example, the most commonly used ICD-9 category is 739 segmental and somatic dysfunction. The fourth character in the code ranges from zero to nine and outlines the anatomic region. The most likely ICD-10 equivalent category is M99.0segmental and somatic dysfunction, and the number of code options is unchanged. In this case, there is a fifth character in the code, but they still outline the same anatomical details as the fourth character hom the ICD-9 codes. However, that is not the end of the possibilities. Upon browsing the Tabular List, an astute observer will also notice a nearby code option: M99.1subluxation complex (vertebral). While the code description may appeal to the chiropractic physician, initial reports suggest that payers will not recognize this code as a replacement for 739, primarily because the ICD-10 equivalent is not 739 based on General Equivalence Mappings (GEMs). Nonetheless, it is an option worth considering. Therefore, the 739 codes have the following replacement options:
M99.0Segmental and somatic dysfunction (10 possible code options) M99.1Subluxation complex (vertebral) (10 possible code options)
There are 20 options between M99.0and M99.1-. However, a reverse crosswalk using GEMs indicates that M99.1may be more correctly matched to 839, which includes “closed dislocations of the vertebrae.”
If the alphabetical index is consulted, and the term “subluxation” is selected, another possible code becomes apparent. S13
is a category that includes “subluxation of cervical vertebrae,” but S23.1and S33.1are the options for the thoracic and lumbar spinal regions, respectively. Again, the word choice here would appeal to chiropractors, however this code appears to be equivalent to 839 rather than 739, based again on GEMs.
513.1Subluxation of cervical vertebrae (27 possibilities)
523.1Subluxation of thoracic vertebrae (36 possibilities)
533.1Subluxation of lumbar vertebrae (15 possibilities)
This represents 78 replacements for the ICD-9 codes used
by chiropractors horn the category 839. It becomes apparent that the short list of top ICD-10 codes is not very short at all.
Spinal Pain 723.1 Cervical, 724.1 Thoracic, 724.2 Lumbar
The next most commonly used ICD-9 codes in chiropractic are for cervical, thoracic, and lumbar pain. The ICD-9 codes are:
723.1 Cervicalgia
724.1 Pain in the thoracic spine
724.2 Lumbago
Each code has a single equivalent in ICD-10 using GEMs, however further investigation will show that there are actually several more possibilities. A thorough understanding of ICD-10 conventions and guidelines is necessary in order to identify all of these options. For example, 723.1 maps to M54.2 cervicalgia. However, the Excludes1 note identifies an
alternative consideration. Category M50,includes cervicalgia due to intervertebral disc disorder. Therefore, if this is what the patient really has, this code should be reported instead. The category M54 dorsalgia has an Excludes 1 note that offers up F45.41 psychogenic dorsalgia. This means that this code also should be considered as an alternative.
The code 724.1 maps directly to M54.6pain in the thoracic spine, but the Excludes 1 note identifies M5Epain in thoracic spine due to intervertebral disc disorder as an alternative consideration. The F45.41 code could also apply instead since the Excludes 1 note applies to all codes that aie in the M54 category.
Code 724.2 maps to M54.5 low back pain. This code offers alternative descriptions, including “loin pain” and “lumbago NOS.” Further, there are three Excludes 1 notes for this code. They include
S39.012 Low back strain
M51.2Lumbago due to intervertebral disc displacement
M54.4Lumbago with sciatica
All of these codes should be considered instead. If the documentation matches, then these codes should be selected. To summarize, all three commonly used spinal pain ICD-9 codes could be replaced with F45.41 pyschogenic dorsalgia. Each one also has an alternative code for pain due to intervertebral disc displacement, and the lumbago code offers a few other alternatives. That makes a total of seven replacement possibilities for the three ICD-9 codes, which is a modest but noticeable increase.
728.85 Spasm of Muscle
Another very commonly used ICD-9 code by chiropractors is 728.85 spasm of muscle. Unfortunately, it is not a very specific code, and, technically, it is listed in a category that “excludes the back.” ICD-10 does help to clarify and improve on the options available to chiropractic physicians, but only slightly, despite providing a wide array of considerations. The GEMs provide two options:
M62.40 Contracture of muscle, unspecified site
M62.838 Other muscle spasm
Unspecified codes, such as M62.40, should always be investigated. In this case, the subcategory M62.4is for “contracture of muscle,” or “contracture of tendon {sheath).” There are 24 codes in this subcategory, each separated by body region, therefore all 24 should be considered (however, eight of the codes are unspecified and should be avoided if possible).
M62.8is the subcategory for muscle spasm and only three codes are offered. They include:
M62.830 Muscle spasm of back
M62.831 Muscle spasm of calf including “charley horse ”
M62.838 Other muscle spasm
All three of these should be considered, but chiropractors will most frequently use M62.830 muscle spasm of back. Another one
that might be useful in a chiropractic setting is M62.49 contracture of muscle, multiple sites. Nonetheless, this actually amounts to 27 potential replacements. However, a few more options should still be considered. Upon examination of the instructional notes found after the category heading, M62 other disorders of muscle, five codes ai e listed as alternatives under the Exlcudes 1 heading. The most relevant to chiropractic include:
R25.2 Cramp and spasm
M79.1 Myalgia, myofascial pain syndrome
These two codes should be considered and selected, if appropriate. However, R25.2 cramp and spasm is in the “Signs and Symptoms” chapter and should only be used when a more definitive diagnosis is not known, or the symptom is not routinely associated with the other diagnoses used in the case. Furthermore, there is one code found under the Excludes2 note for the M62 category. It tells us that M79.81 nontraumatic hematoma of muscles should be considered in addition to the code that is selected from the M62 category. With these considerations, that means there are 33 ICD-10 codes to consider instead of, or in addition to, 728.85.
Short List or Decision Tree?
The short list of top ICD-10 codes is elusive because the considerations are too numerous. Listing all of these codes on a cheat sheet may be somewhat impractical. A sort of software algorithm or decision-making tree may be a better solution. It can be mapped out on a big sheet of paper, or there may be software programs with these algorithms already built into them. Many practice management software programs have imported the GEMs, but have not gone so far as to include algorithms to guide code selection. Following the previous example for 728.85 spasm of muscle, the GEMs spit out only two codes, but direct investigation of the code set leads to 33 code possibilities. In other words, software tools ai e not a substitute for the ability to navigate the Tabular List of codes in the otftcial ICD-10 code set. The clinician and coder must be familiar with the codes, and reliance on a third-party tool may be foolhardy.
This article only reviewed a few of the most common codes used by chiropractors. If other popular codes aie considered as well, the list becomes even longer with even more branches. A provider may want a simple list of the top codes, but an understanding of the Tabular List and its conventions is necessary to become prepared for ICD-10 implementation, which will minimize revenue interruption.
Reference:
1. 2015 International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM)
Dr. Evan Gwilliam is the vice president of the ChiroCode Institute, which provides seminars, coding books, and online education for doctors of chiropractic. He is one of the few clinicians also certified as an ICD-10 Instructor by the American Academy of Professional Coders, and he holds several other credentials in insurance coding and compliance. He can be reached at DrG(f ChiroCode. com.
