ICD-10 Implementation Toolkit | Chiropractic Care of Minnesota, Inc.

ICD-10 Implementation Toolkit

Supporting you Over the Hurdles

Introduction

October 1, 2015, is the deadline for ICD-10. If you have questions or have fallen behind in your preparations and training, this toolkit is for you.

Chiropractic Care of Minnesota Inc. has created and gathered an abundance of educational and supporting resources to assist chiropractors through the transition from ICD-9 to ICD-10. This toolkit combines the most valuable resources to help guide you over the ICD-10 hurdles.

Contents Implementation Checklist + Quick Tips ICD-10 for the Chiropractic Procrastinator Chiropractic ICD-10 Common Codes List Frequently Asked Questions Additional Resources List

ICD-10 Implementation Toolkit | Chiropractic Care of Minnesota, Inc.

ICD-10 Implementation Checklist + Quick Tips

☐ Watch ChiroCare’s “Gauging ICD-10 Readiness” webinar with your staff members. This recording

provides a quick 60-minute overview of the transition basics.

☐ Compile a list of all the places (paper and electronic) ICD-9 codes are used in your clinic today.

Some examples may include routing slips, billing paperwork, accounts receivable, etc.

☐ Refer to ChiroCare’s Chiropractic ICD-10 Common Codes List codes (included in this toolkit and

available online) for a preliminary list of common ICD-10 codes chiropractic diagnoses.

☐ Use the inventory sheet of ICD-9 codes you collected from February to identify what processes, forms

and systems need to change for the October 1, 2015 deadline. Modify these policies and procedures.

Revise these paper forms and templates.

☐ Just about everyone in your office will need some sort of training, including medical coders and

clinical staff. Make sure everyone is comfortable with codes as well as workflow changes – especially if

you have new or upgraded systems.

☐ Conduct internal tests. Review ChiroCare’s ICD-10 Internal and External Testing Procedures document offers some great tips to help get you started.

☐ Work out any testing errors internally or with vendors.

☐ Practice coding with ICD-10 and validate supporting clinical documentation processes

Quick Tips_____________________________________________________________________

Bill by date of service (DOS) – use ICD-9 codes for DOS until 9/30/2015; and ICD-10 codes should be used on all claims with DOS on or after 10/1/2015

Claims for DOS on or after 10/1/2015 that use ICD-9 codes will be denied – there is no grace period

Chiropractic manipulation codes are the M99.XX codes

Some codes have three digits and others have seven digits to be complete. Double-check the tabular list to be certain the code is a complete code!

Combination Codes are new with ICD-10 (e.g., lumbago with sciatica (right) is one code M54.1)

Watch for exclusion codes o Excludes 1 = mutually exclusive code - consider these codes INSTEAD (e.g., 54.5 low back

pain excludes S39.012 low back strain) o Excludes 2 = not includes - consider this code IN ADDITION (e.g., strain S16.1xxx and

sprain S13.4xxx may both be diagnoses)

ICD-10 for the Chiropractic Procrastinator

Presented By

Chiropractic Care of Minnesota, Inc. (CCMI)

Authored By

Dr. Evan Gwilliam, DC, MBA, BS, CPC, CCPC, NCICS, CCCPC, CPC-I, CPMA, MCS-P

Introduction

You have put it off long enough. It is time to become proficient with ICD-10 or face the risk of claims not

being paid for dates of service beginning October 1, 2015. The following pages contain tips and

suggestions on how to get started with the new coding approach. However, remember that learning

ICD-10 is a bit like learning to speak a new language - it cannot be taught in a few pages. Be sure to also

check out additional resources at the end of this Guide to support you over the ICD-10 hurdles.

ICD-10 for the Chiropractic Procrastinator 2

Table of Contents

ICD-10 Structure & Fundamentals ……………………………………………………………………………………………….………2-3

ICD-10 Terminology & Definitions……………………………………………….……………………………………………………….3-5

General Tips …………………………………………………………………………………………………………………………………………..6

Strategies for Finding the Right Codes…………………………………………………………………………………………………6-7

How to Use the ICD-10 Coding for Chiropractic Book ……………………………………………………………………………..7

Where to Find More Information …………………………………………………………………………………………………………..7

ICD-10 Structure & Fundamentals

ICD-10 codes are organized into chapters, separated by body system or condition, just like ICD-9.

Chiropractors will mostly use codes from the following chapters of the official Tabular List, which is

abridged in ChiroCode’s ICD-10 Coding for Chiropractic book: Chapter 6 (G Codes – Diseases of the

Nervous system), Chapter 13 (M Codes – Diseases of the Musculoskeletal System and Connective

Tissue), Chapter 18 (R Codes – Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not

Elsewhere Classified), Chapter 19 (S Codes - Injury), and maybe Chapter 20 (V, W, X, and Y Codes –

External Causes of Morbidity).

ICD-10 codes contain up to seven characters and they contain numbers as well as letters.

The first three characters are the category; all codes in the same category are a related

condition (i.e. M47 is the category for Spondylosis).

ICD-10 for the Chiropractic Procrastinator 3

The next three characters provide detail about things like the anatomical site and severity; in some cases, they may be replaced by the “x” to ensure that the seventh character remains in the seventh position.

Be careful about specifying the difference between the number zero “0” and the letter “O”. The

same is true of “1”, “L”, and “I.”

The sixth character frequently denotes laterality (1=right; 2=left). When there is no bilateral

code, you need to list the right and left code separately.

The seventh character for certain injury codes (encounter or episode of care) will usually only

be used by chiropractors for sprain and strain codes (i.e. S23.3xx_ Sprain of Ligaments of

Thoracic Spine.) The “_” underscore indicates that a seventh character is required. They usually

include the following three options.

o A – Initial encounter: patient is receiving active treatment. Payers may recognize this as

a phase of care, rather than a single visit. It may be required when establishing medical

necessity for chiropractic care.

o D- Subsequent encounter: routine care during the healing or recovery phase/support

care. This may be considered appropriate for all visits after the initial visit, or it may be

viewed as maintenance care.

o S – Sequela: complications or conditions that arise as a direct result of the condition.

This would be applied to a condition which is no longer present, but it led to another

problem, which is the primary reason for the encounter.

ICD-10 Terminology & Definitions

Acute Conditions - The medical conditions characterized by sudden onset, severe change, and/or short duration.

Additional Diagnosis - The secondary diagnosis code used, if available, to provide a more complete picture of the primary diagnosis.

And - Means "and/or" when it appears in a title or narrative statement. Example: S33 says “Dislocation and sprain”, which can mean either sprain and/or dislocation.

Bilateral - For bilateral sites, the final character of the codes in the ICD-10-CM indicates laterality. An unspecified side code is also provided should the side not be identified in the medical record. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

Brackets [ ] - Punctuation found in both the Tabular List and the Alphabetic Index surrounding manifestation codes to indicate that the manifestation should be sequenced after the disease code.

Chronic Conditions - Medical conditions characterized by long duration, frequent recurrence over a long period of time, and/or slow progression over time.

ICD-10 for the Chiropractic Procrastinator 4

Code Also - Instruction that tells the coder that more than one code could be assigned, but it does not imply any sequencing guidance. Generally the most serious condition should be listed first.

Code First - Instructs the coder to assign the code for the underlying disease before the code for the manifestation of the disease and generally accompanies a manifestation code. This note is not common for musculoskeletal codes.

Colon : - Punctuation found in the Tabular List when a term must be modified by the addition of another term in order to qualify it for assignment of a specific code or to a category.

Combination Codes - A single code used to classify any of the following: two diagnoses; a diagnosis with an associated secondary process (manifestation); or a diagnosis with an associated complication.

Crosswalk/mapping - Moving from one code set to another. This is generally done with GEMs, but can be customized.

Excludes - "Excludes" as used in ICD-9-CM indicates that the code should not be used, because another code may be more appropriate. "Excludes" notes usually include suggestions of more appropriate codes or code ranges. ICD-10-CM introduces two types of excludes: "Excludes1" and "Excludes2".

o Codes/conditions listed in the "Excludes1" notes should not be used because the two conditions do not occur together. It may be helpful to think of the “Excludes1” list to be codes that might be suggested instead.

o Codes/conditions listed in the "Excludes2" notes indicate that the conditions being excluded are not considered part of the subject condition, but that another code should also be assigned. It may be helpful to think of “Excludes2” codes to those that might need to be added to provide full detail.

o Codes may have both, either or neither Excludes1 and Excludes2 notes.

GEMs - Generated by the National Center for Health Statistics, this reference mapping attempts to include all valid relationships between the codes in the ICD-9-CM diagnosis classification and the ICD-10-CM diagnosis classification. CMS warns not to code directly from GEMs, as they only provide approximations. Note that GEMs frequently point to “unspecified” ICD-10 codes, which may lead to denied claims.

Includes - Term that is accompanied by conditions that are examples of what may be included in a specific category.

NEC - “Not elsewhere classified” or “other specified” is used when the information in the medical record provides detail for which a specific codes does not exist. Example M53.86 Other specified dorsopathies, lumbar region might be used for “facet syndrome”. The code does not name the condition, but the documentation does.

Nonessential Modifiers - Terms that may coexist with the main term but do not change the code assignment for the condition. These are generally contained within parentheses.

ICD-10 for the Chiropractic Procrastinator 5

NOS - “Not otherwise specified” or “unspecified” is used when the information in the medical record is insufficient to assign a more specific code. Example: M54.9 Dorsalgia unspecified. The code is vague, but so is the documentation.

Manifestation Codes - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. However, these are uncommon for musculoskeletal diagnoses that are most likely to be used by chiropractors.

Medical Necessity - Services or supplies that: are proper and needed for the diagnosis or treatment of a medical condition; are provided for the diagnosis, direct care, and treatment of a medical condition; meet the standards of good medical practice in the local area; and are not mainly for the convenience of the patient or doctor. Diagnosis codes convey this information.

Parentheses ( ) - Punctuation found in both the Tabular List and the Alphabetic Index that surrounds nonessential modifiers. Example: M99.1- subluxation complex (vertebral). The word “vertebral” is not essential to the code description.

Principle Diagnosis - First-listed/primary diagnosis code. The code sequenced first on a medical record defines the primary reason for the visit as determined at the end of the encounter.

Signs/Symptoms - Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

See - Term used in the Alphabetic Index to instruct the coder to refer to another term.

See Also - Term used in the Alphabetic Index to instruct the coder to refer to another term if desired.

Sequelae - A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury.

With - Term used in the alphabetic index immediately following the main term, but not necessarily in alphabetic order in the Alphabetic Index. It is defined as “associated with” or “due to”. If not specified in the documentation, the default is “without”.

ICD-10 for the Chiropractic Procrastinator 6

General ICD-10 Tips

Claims for dates of service prior to October 1, 2015 must use ICD-9 codes. Claims for dates of

service after October 1, 2015 must use ICD-10 codes.

The ICD-10 code set was last updated in 2012, and will not change again until 2016

Personal Injury insurance policies and workers compensation plans are not required to adopt

ICD-10 codes, but it is expected that they will. You are encouraged to contact them directly to

make sure.

Do not code diagnoses documented as ‘probable’, ‘suspected’, ‘questionable’, ‘rule out’, or

‘working diagnosis’ or other terms indicating uncertainty. Example: if you suspect a disc

herniation, you may need MRI to confirm before using a disc related diagnosis code.

Signs and symptoms (mostly Chapter 18, R codes) should only be coded if a more definitive

diagnosis has not been identified, or if they are not routinely associated with other codes

assigned to the encounter. External Cause codes (Chapter 20, V, W, X, and Y)

o Do not provide a diagnosis, rather they provide data about the location, activity, or

circumstances of an injury or poisoning

o Are not mandatory, but voluntary reporting is encouraged

o May be used by chiropractors with acute injuries, such as auto accidents or worker’s

comp claims

o Are always listed last on a claim form

Strategies for Finding the Right Codes

General Strategies

1. Use GEMs mapping in the ChiroCode book (pages 56-137) or your EMR software. Then confirm the choice in the Tabular List. Be wary of unspecified codes.

2. Use the Common Codes list in the ChiroCode book (pages 44-56). Then confirm the choice in the Tabular List. Be sure to review all the instructional notes within the Tabular List.

3. Look up the key terms from the provider documentation in the Alphabetic Index (pages 455-472). Then confirm the code(s) in the Tabular List. Consider synonyms if you can’t find the term you are looking for.

Improving ICD-10 documentation

1. Find ICD-10 codes for existing records in your office. 2. Compare the existing documentation to the new codes. 3. If inadequate, add details to a practice record. 4. For every patient that presents in the future with that condition, include the new details in

your documentation.

ICD-10 for the Chiropractic Procrastinator 7

Administrative steps

Be prepared for the possibility of delayed payments due to issues regarding processing and

payer policies for new codes. Consider securing financing to allow you to meet obligations

should revenue temporarily decline.

Reach out to payers and your clearinghouse and ask if they will accept test claims prior to

October 1, 2015.

Plan to train your entire office a little each week. Consider using articles from trade journals or

reading the first 43 pages of the ChiroCode ICD-10 book.

How to use the “ICD-10 Coding for Chiropractic Book”

The first 43 pages summarize all you need to know about ICD-10:

detailed explanations of the terms identified in this guide.

The “Commonly Used Codes” (about 12 pages) section provides you

with a shortcut list sorted by anatomical region. Note that this list is

only a best guess, since ICD-10 has not actually been used yet.

The “Code Mapping” (about 90 pages) section provides you with

GEMs tables to translate from ICD-9 to ICD-10 codes. Watch out for

unspecified codes.

The “Tabular List” (about 300 pages) contains an abridged version of

the full code set. Most of the codes included are musculoskeletal

conditions and acute injury codes (sprains and strains).

o An arrow at the bottom of a page means highest specificity and if the code is bold, it

means it is complete (right number of characters).

o Pay particular attention to instructional notes at the level of each code character.

The “Alphabetic Index” (about 20 pages) can be used to find codes by key terms that are

included in the documentation. Beware that the index usually only provides the first three or

four characters of a code.

The “Appendix” (about 40 pages) contains an abbreviated version of the official guidelines for

ICD-10 coding.

Where to Find More Information

Visit CCMI’s ICD-10 Transition Support web page for articles and other resources

Go to ChiroCode.com and use coupon code CCMI20 to get $20 off ChiroCode’s “ICD-10 Coding

for Chiropractic” book. It contains everything you need to make the transition. (Please contact

ChiroCode directly with any questions regarding your order or the coupon code at (602) 944-

9877 and allow one week for delivery.)

Visit CMS’ Road to 10 web page for free ICD-10 resources from Medicare

Chiropractic ICD-10 Common Codes List | Chiropractic Care of Minnesota, Inc.

Chiropractic ICD-10 Common Codes List

This is a preliminary list of common ICD-10 codes for chiropractic diagnoses. This is a common code list to be used as a guide for coding and is not intended to represent all ICD-10 codes accepted by ChiroCare. Using codes on this list does not guarantee that the claim will not be denied. Using valid ICD-10 codes can facilitate authorization, claims payments and support the medical necessity of the service in case of review, audits or litigation. Codes must support neuromusculoskeletal (NMS) conditions, and represent the body regions requiring treatment. Please list the diagnosis primarily responsible for the treatment in the primary position on the claim form. ChiroCare further recommends that the secondary, tertiary and quaternary diagnosis positions on the claim form be used to report additional conditions/regions that are being treated.

ICD-10 Diagnosis Code

Code Description/Condition Name

Headache R51 Headache G44.201 Tension-type headache, unspecified, intractable G44.209 Tension-type headache, unspecified, not intractable G43.001 Migraine without aura, not intractable, with status migrainosus G43.009 Migraine without aura, not intractable, without status migrainosus G43.011 Migraine without aura, intractable, with status migrainosus G43.019 Migraine without aura, intractable, without status migrainosus G43.101 Migraine with aura, not intractable, with status migrainosus G43.109 Migraine with aura, not intractable, without status migrainosus G43.111 Migraine with aura, intractable, with status migrainosus G43.119 Migraine with aura, intractable, without status migrainosus

Cervical M54.2 Cervicalgia M99.01 Segmental and somatic dysfunction of cervical region S13.4XXA Sprain of ligaments of cervical spine, initial encounter S16.1XXA Strain of muscle, fascia and tendon at neck level, initial encounter M50.11 Cervical disc disorder with radiculopathy, occipito-atlanto-axial region M50.12 Cervical disc disorder with radiculopathy, mid-cervical region M50.13 Cervical disc disorder with radiculopathy, cervicothoracic region M50.31 Other cervical disc degeneration, occipito-atlanto-axial region M50.32 Other cervical disc degeneration, mid-cervical region M50.33 Other cervical disc degeneration, cervicothoracic region M48.01 Spinal stenosis, occipito-atlanto-axial region M48.02 Spinal stenosis, cervical region

Chiropractic ICD-10 Common Codes List | Chiropractic Care of Minnesota, Inc.

Cervical, Continued M48.03 Spinal stenosis, cervicothoracic region M43.6 Torticollis M47.811 Spondylosis without myelopathy or radiculopathy, offipito-atlanto-axial region M47.812 Spondylosis without myelopathy or radiculopathy, cervical region M47.813 Spondylosis without myelopathy or radiculopathy, cervicothoracic region M41.112 Juvenile idiopathic scoliosis, cervical region M41.113 Juvenile idiopathic scoliosis, cervicothoracic region M41.122 Adolescent idiopathic scoliosis, cervical region M41.123 Adolescent idiopathic scoliosis, cervicothoracic region M41.41 Neuromuscular scoliosis, occipito-atlanto-axial region M41.42 Neuromuscular scoliosis, cervical region M41.43 Neuromuscular scoliosis, cervicothoracic region M53.81 Other specified dorsopathies, occipito-atlanto-axial region M53.82 Other specified dorsopathies, cervical region M53.83 Other specified dorsopathies, cervicothoracic region M54.11 Radiculopathy, occipito-atlanto-axial region M54.12 Radiculopathy, cervical region M53.1 Cervicobrachial syndrome G54.0 Brachial plexus disorders

Thoracic and Ribs M54.6 Pain in thoracic spine M99.02 Segmental and somatic dysfunction of thoracic region M99.08 Segmental and somatic dysfunction of rib cage S23.3XXA Sprain of ligaments of thoracic spine, initial encounter S23.41XA Sprain of ribs, initial encounter S23.421A Sprain of chondrosternal joint, initial encounter M51.14 Intervertebral disc disorders with radiculopathy, thoracic region M53.84 Other specified dorsopathies, thoracic region M41.114 Juvenile idiopathic scoliosis, thoracic region M41.124 Adolescent idiopathic scoliosis, thoracic region M41.44 Neuromuscular scoliosis, thoracic region

Lumbosacral & Pelvic M54.5 Low back pain M99.03 Segmental and somatic dysfunction of lumbar region M99.04 Segmental and somatic dysfunction of sacral region M99.05 Segmental and somatic dysfunction of pelvic region S33.5XXA Sprain of ligaments of lumbar spine, initial encounter S33.6XXA Sprain of sacroiliac joint, initial encounter S33.8XXA Sprain of other parts of lumbar spine and pelvis, initial encounter S33.9XXA Sprain of unspecified parts of lumbar spine and pelvis, initial encounter S39.012A Strain of muscle, fascia and tendon of lower back, initial encounter M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region M51.16 Intervertebral disc disorders with radiculopathy, lumbar region M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region

Chiropractic ICD-10 Common Codes List | Chiropractic Care of Minnesota, Inc.

Lumbosacral & Pelvic, Continued M51.36 Other intervertebral disc degeneration, lumbar region M51.37 Other intervertebral disc degeneration, lumbosacral region M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region M54.31 Sciatica, right side M54.32 Sciatica, left side M54.41 Lumbago with sciatica, right side M54.42 Lumbago with sciatica, left side M54.16 Radiculopathy, lumbar region M54.17 Radiculopathy, lumbosacral region M53.3 Sacrococcygeal disorders, not elsewhere classified M53.85 Other specified dorsopathies, thoracolumbar region M53.86 Other specified dorsopathies, lumbar region M48.06 Spinal stenosis, lumbar region M48.07 Spinal stenosis, lumbosacral region M41.115 Juvenile idiopathic scoliosis, thoracolumbar region M41.116 Juvenile idiopathic scoliosis, lumbar region M41.117 Juvenile idiopathic scoliosis, lumbosacral region M41.125 Adolescent idiopathic scoliosis, thoracolumbar region M41.126 Adolescent idiopathic scoliosis, lumbar region M41.127 Adolescent idiopathic scoliosis, lumbosacral region M41.45 Neuromuscular scoliosis, thoracolumbar region M41.46 Neuromuscular scoliosis, lumbar region M41.47 Neuromuscular scoliosis, lumbosacral region

Upper Extremity M99.07 Segmental and somatic dysfunction of upper extremity G56.01 Carpal tunnel syndrome, right upper limb G56.02 Carpal tunnel syndrome, left upper limb M75.01 Adhesive capsulitis of right shoulder M75.02 Adhesive capsulitis of left shoulder M75.51 Bursitis of right shoulder M75.52 Bursitis of left shoulder M77.01 Medial epicondylitis, right elbow M77.02 Medial epicondylitis, left elbow M77.11 Lateral epicondylitis, right elbow M77.12 Lateral epicondylitis, left elbow S43.51XA Sprain of right acromioclavicular joint, initial encounter S43.52XA Sprain of left acromioclavicular joint, initial encounter S43.411A Sprain of right coracohumeral (ligament), initial encounter S43.412A Sprain of left coracohumeral (ligament), initial encounter S43.421A Sprain of right rotator cuff capsule, initial encounter S43.422A Sprain of left rotator cuff capsule, initial encounter S46.011A Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter S46.012A Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial encounter S46.091A Other injury of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter S46.092A Other injury of muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial encounter

Chiropractic ICD-10 Common Codes List | Chiropractic Care of Minnesota, Inc.

Upper Extremity, Continued S46.811A Strain of other muscles, fascia and tendons at shoulder and upper arm level, right arm, initial encounter S46.812A Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, initial encounter S43.81XA Sprain of other specified parts of right shoulder girdle, initial encounter S43.82XA Sprain of other specified parts of left shoulder girdle, initial encounter M25.511 Pain in right shoulder M25.512 Pain in left shoulder M25.521 Pain in right elbow M25.522 Pain in left elbow M25.531 Pain in right wrist M25.532 Pain in left wrist M79.601 Pain in right arm M79.602 Pain in left arm M79.621 Pain in right upper arm M79.622 Pain in left upper arm M79.631 Pain in right forearm M79.632 Pain in left forearm M79.641 Pain in right hand M79.642 Pain in left hand M79.644 Pain in right finger(s) M79.645 Pain in left finger(s)

Lower Extremity M99.06 Segmental and somatic dysfunction of lower extremity M76.61 Achilles tendinitis, right leg M76.62 Achilles tendinitis, left leg M76.811 Anterior tibial syndrome, right leg M76.812 Anterior tibial syndrome, left leg M76.819 Anterior tibial syndrome, unspecified leg M76.821 Posterior tibial tendinitis, right leg M76.822 Posterior tibial tendinitis, left leg M76.829 Posterior tibial tendinitis, unspecified leg S73.191A Other sprain of right hip, initial encounter S73.192A Other sprain of left hip, initial encounter S76.011A Strain of muscle, fascia and tendon of right hip, initial encounter S76.012A Strain of muscle, fascia and tendon of left hip, initial encounter S83.401A Sprain of unspecified collateral ligament of right knee, initial encounter S83.402A Sprain of unspecified collateral ligament of left knee, initial encounter S83.501A Sprain of unspecified cruciate ligament of right knee, initial encounter S83.502A Sprain of unspecified cruciate ligament of left knee, initial encounter S83.91XA Sprain of unspecified site of right knee, initial encounter S83.92XA Sprain of unspecified site of left knee, initial encounter S93.411A Sprain of calcaneofibular ligament of right ankle, initial encounter S93.412A Sprain of calcaneofibular ligament of left ankle, initial encounter S93.421A Sprain of deltoid ligament of right ankle, initial encounter S93.422A Sprain of deltoid ligament of left ankle, initial encounter S93.431A Sprain of tibiofibular ligament of right ankle, initial encounter

Chiropractic ICD-10 Common Codes List | Chiropractic Care of Minnesota, Inc.

Lower Extremity, Continued S93.432A Sprain of tibiofibular ligament of left ankle, initial encounter S96.811A Sprain of other specified muscles and tendons at ankle and foot level, right foot, initial encounter S96.812A Sprain of other specified muscles and tendons at ankle and foot level, left foot, initial encounter M79.604 Pain in right leg M79.605 Pain in left leg M79.651 Pain in right thigh M79.652 Pain in left thigh M79.661 Pain in lower right leg M79.662 Pain in lower left leg M79.671 Pain in right foot M79.672 Pain in left foot M79.674 Pain in right toe(s) M79.675 Pain in left toe(s) M25.551 Pain in right hip M25.552 Pain in left hip M25.561 Pain in right knee M25.562 Pain in left knee M25.571 Pain in right ankle M25.572 Pain in left ankle

Other Diagnoses (do not use as primary code) M62.830 Muscle spasm of back M79.1 Myalgia M79.7 Fibromyalgia

www.chirocare.com I info@chirocaremn.org I MN Office: 651-389-2006 I WI Office: 414-476-4733

ICD-10 Transition

Frequently Asked Questions

1. When is the ICD-10 compliance deadline?

The ICD-10 deadline is October 1, 2015.

2. Is it the Date of Service (DOS) that determines ICD-9 or 10?

Yes. DOS before October 1, 2015 are submitted using ICD-9. DOS on or after October 1, 2015

are submitted using ICD-10.

3. What happens if I submit ICD-9 for DOS after October 1, 2015?

The claim will be denied.

4. Is there any grace period to submit ICD-9 after October 1, 2015?

No. For DOS on and after October 1, 2015 – ICD-10 is required.

5. Do ICD-10 codes need to be reported for all products?

Yes. ICD-10 codes must be used for all services provided on or after October 1, 2015, regardless

of the type of insurance product the member holds.

6. Codes change every year so why is the transition to ICD-10 any different from the

annual code changes?

ICD-10 codes are completely different from ICD-9 codes. Currently, ICD-9 codes are mostly

numeric and have 3 to 5 digits. ICD-10 codes are alphanumeric and contain 3 to 7 characters.

The change is significant, so it is wise to begin your transition process now.

7. Will ICD-10 replace Current Procedural Terminology (CPT) coding?

No. The transition to ICD-10 is for diagnostic codes and does not affect CPT coding for

outpatient procedures and practitioner services.

8. Why is the switch to ICD-10 happening?

The Centers for Medicare & Medicaid Services (CMS) is requiring the

transition to ICD-10 because it allows for more accurate description of the

patients’ medical condition and creates a structure of ICD codes that can

expand the number of diagnostic codes available.

www.chirocare.com I info@chirocaremn.org I MN Office: 651-389-2006 I WI Office: 414-476-4733

9. What should I do to prepare for the transition to ICD-10?

Buy the ICD-10 Coding for Chiropractic book, from ChiroCode or the American

Chiropractic Association (ACA)

Attend a Seminar: See ChiroCare.com/Events

Prepare a budget for transition and claim delays

Set up a staff transition team and timeline

Talk about the clinic work flow and where ICD codes are being used

Check with software and billing vendors and clearinghouses on their ICD-10 readiness

10. Where can I find ICD-10 codes and crosswalks?

Find a Code: Findacode.com (phone app)

American Association of Professional Coders (AAPC): aapc.com

Disclaimer: ICD-10 mapping or crosswalks for ICD-9 codes often do not directly code to

ICD-10 and requires a clinical analysis to determine which code should be selected

11. What is my timeline?

In order to avoid costly claims denials and rejections, begin the transition early. The

recommendation is to be ready for internal ICD-10 testing in June and do external testing with

vendors in July. This will provide time to identify errors and find solutions before the October 1

deadline.

12. Where can I find more ICD-10 Resources?

ChiroCare: chirocare.com/ICD-10

ChiroCode: chirocode.com

American Chiropractic Association: acatody.org

(Electronic toolkit available for purchase)

Centers for Medicare and Medicaid Services: cms.gov

The Small Practitioners Practice’s Route to ICD-10: roadto10.org

(Free Interactive website with good clearinghouse/vendor questions lists and timeline

recommendations.)

Minnesota Chiropractic Association: mnchiro.com

Healthcare IT News and Healthcare Finance News: icd10watch.com

ICD-10 Implementation Toolkit | Chiropractic Care of Minnesota, Inc.

ICD-10 Additional Resources List

ChiroCode

American Chiropractic Association

Centers for Medicare and Medicaid Services

American Association of Professional Coders (AAPC)

Find a Code

Healthcare IT News and Healthcare Finance News

ChiroCare – Helping you over the ICD-10 Hurdles and through the finish line.