In 2023, chiropractors have to deal with several medical coding changes. The ICD-10 code changes that came into effect on Oct 1, 2022 comprise 1176 new codes, 28 revised codes and 287 deleted codes. For chiropractors, there are new ICD-10 codes for lumbar and lumbosacral disc disorders, spinal muscles weakness and atrophy, and more. There are also changes to coding and documenting for E/M services that chiropractors have to deal with in 2023. A chiropractic coding company can help practices submit accurate claims using the new codes and streamline their medical billing and coding process.
Key ICD-10 Code Updates for Chiropractors
- Thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders: There are new codes for lower back conditions, specifically to identify annulus fibrous defect (disc) of the lumbar and lumbosacral spine. These new codes aim to enable more specific diagnoses:
M51.0 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with myelopathy
M51.1 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with radiculopathy
M51.2 Other thoracic, thoracolumbar and lumbosacral intervertebral disc displacement
M51.3 Other thoracic, thoracolumbar and lumbosacral intervertebral disc degeneration
There are 7 new codes for reporting annular defects in the lumbar and lumbosacral regions:
M51.A Other lumbar and lumbosacral annulus fibrosus disc defects
M51.A0 Intervertebral annulus fibrosus defect, lumbar region, unspecified size
M51.A1 …small, lumbar region
M51.A2 …large, lumbar region
M51.A: …lumbosacral region, unspecified size
M51.A4 …small, lumbosacral region
M51.A5 …large, lumbosacral region
- Spinal muscle wasting and atrophy: There are new codes for specifically identifying spinal regions. New codes for spinal muscle wasting and atrophy include:
M62.5 Muscle wasting and atrophy, not elsewhere classified, back
M62.5A0: …cervical
M62.5A1: …thoracic
M62.5A2: …lumbosacral
M62.5A9: …unspecified level
- Concussion: There are changes to concussion codes to identify a concussion with unknown loss of consciousness. There is new subcategory: S06.0XA.
S06.0XA- Concussion with loss of consciousness status unknown
S06.0XAA …initial encounter
S06.0XAD …subsequent encounter
S06.0XAS …sequela
- Slipped Upper Femoral Epiphysis (Nontraumatic): Slipped upper femoral epiphysis is “a disorder of adolescents in which the growth plate is damaged and the femoral head moves (“slips”) with respect to the rest of the femur. The head of the femur stays in the cup of the hip joint while the rest of the femur is shifted” (John Hopkins Medicine).
Starting Oct. 1, 2022, more diagnoses were added to the Slipped Upper Femoral Epiphysis (Nontraumatic) (M93.0-) code set. Here are a few of the changes:
- The expanded M93.0-code sets have more five and six-character options – adds specificity as to the severity of the epiphysis (unspecified, acute, chronic, acute on chronic)
- Many codes indicate laterality
- New M code category for sternum and rib fractures associated with chest compression and cardiopulmonary resuscitation
- “Stable” was added to M93.01-, M93.02-, M93,03-
- Post-viral fatigue syndrome: There is a new code to identify post-viral fatigue syndrome: G93.31. According to an article in dynamicchiropractice.com, this syndrome may be a factor that hinders a patient’s recovery from common chiropractic conditions. Many insurers require identifying complicating conditions and comorbidities in the claim documentation
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- E-bike Injuries (V20-V29): Injuries caused by e-bike accidents are different from those caused by motorcycle accidents, and are reported separately within ICD-10 using the letter “V” to indicate an external cause. Many e-bike injury codes were expanded.
V20.2- Unspecified motorcycle rider injured in collision with pedestrian or animal in nontraffic accident
V20.91XA: Unspecified electric (assisted) bicycle rider injured in collision with pedestrian or animal in traffic accident, initial encounter
V21.51XA: Electric (assisted) bicycle passenger injured in collision with pedal cycle in traffic accident, initial encounter
Stay Up to date on E/M Coding
The American Medical Association (AMA) released CPT Evaluation and Management (E/M) Code and guidelines effective January 2023 which builds on the revisions made to the E/M office visit CPT codes (99201-99215) code descriptors and documentation standards made in 2021. The AMA noted: “Documentation of e/m office visits will now be centered around how physicians think and take care of patients and not on mandatory standards that encouraged copy/paste and checking boxes.
The E/M updates address the persistent administrative burden problem for physicians in almost every specialty. Coding processes in nearly all E/M services are simpler and more flexible for providers of chiropractic billing services. Codes 99202-99205 include a “medically appropriate history and examination,” and code selection is based on the level of MDM OR total time spent on the date of the encounter. Chiropractors can also use prolonged services add-on code, 99417 for services longer than 74 minutes. Providers must also be knowledgeable about using the essential CPT codes for chiropractic services 98940-98943 and ensure proper clinical documentation.
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