Blog, Chirosecure Live Event November 14, 2023

Chiropractic Malpractice Insurance – Using the ICD10 Updates for 2024

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Greetings, everyone. Welcome into another program with ChiroSecure. As always, thanks to ChiroSecure for keeping us up to date and what’s not more up to date than what’s gonna happen in 2024. In fact, here’s a riddle for you. When do the 2024 diagnosis begin? And it’s a riddle because actually they already have.

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October, first of the year prior is when ICD 10 codes update. So by example though, I’m talking 2024 diagnosis. They actually began October 1st. So I wanna make sure everyone’s up to date on information to make sure when I bill, am I gonna get paid? Do I have the right code? Let’s go to the slides. Let’s talk about what’s gonna happen or what is happening with diagnosis for 2024, as is every year.

Diagnosis codes are going to update. Some years are a very big change. Like by example. Remember the years all the codes changed for disc, and then we had the change for back pain. We have to make sure what years happen or what happens throughout the years, but more importantly, what’s important to us.

I’ll be honest, I’m pretty centric. I really care about what chiropractors get paid for, but I will say this diagnosis is the lifeblood to having claims paid and understanding what we’re doing. Coding matters. In other words, the code tells us what’s wrong with that patient. Why are we treating them the length of care of the type of care plan we’re doing?

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So the better we are at giving a proper diagnosis, the better we are making sure that people understand what we’re treating and ultimately making sure we’re getting paid. So now, if with diagnosis, always think of it, keep it simple. It is what is wrong with your patient? And remember for insurance, they always want that neuro musculoskeletal diagnosis.

But I just wanna be a little bit careful ’cause is that all really? Is a chiropractor limited to, I can only treat neuro musculoskeletal conditions? Actually, not I. A chiropractor can treat the human condition. Now, I will be careful of saying you can treat things that are way outside like they can cure cancer, things of that nature.

But realize when we talk diagnosis, it’s not just about what will insurance pay, but also what are you seeing? What are you treating that patient for? And remember that beyond the neuro musculoskeletal stuff, it includes comorbidities. Things that are underlying, that may not be things you’re treating directly, but will increase the need for care because they complicate, if you will, the recovery of that patient.

So I want you to start to think of your diagnosis. Is your way of communicating regardless of insurance or just to a patient, what is wrong and why we’re caring for them? As you’re well aware, diagnosis codes do update every year. This year was no different. But they updated October 1st, so make sure if you’re using these codes, they’re gonna be the new ones.

Now here’s the good news for this year, there were no changes to the common codes. If remember two years ago, the headache codes had made updates or the back pain codes, the headache codes, dis codes. This year there was really nothing deleted that we use commonly. So I think a little bit easier for us, but they’ve also updated some codes that allow us to treat or

Really, I would say describe things that we were never able to describe before. So for this year, you can note that there are now 73,674 codes. Do you care about that many codes? My opinion, no. What I care about are the things that are pertinent to us. So even within that though, are you gonna use 73,000 codes?

Of course not. I would bet most chiros have probably not coded more than 25 different conditions their entire career, because we have a tendency to see a lot of the same things. The key for me is making sure, do I have the right information about the condition? Am I treating? Do I have the most UpToDate, most accurate code?

So there were 395 editions this year, and you’re thinking, ooh. 25 codes were deleted, 13 revisions. But what I care about is what’s specific to us as far as neuromuscular skeletal. There were no changes to the common codes you’re all used to, but they did add some codes like last year when they added the annular fiber tear or codes.

They’ve now added some codes for migraines that we’ve never had before. Now this might surprise you a little bit. Notice there’s now codes that indicate chronic migraine. And you’re probably thinking we’ll see ’em. I think there were chronic migraine codes. Actually there weren’t, even though there’s about 40 migraine codes, none indicated chronic.

So we have these new codes for chronic migraines. Now, is that certainly something chiropractors treat and have patients come in for? Absolutely. And the better we are describing it, whether it’s chronic or just an intermittent, non intractable if you will, we wanna start to make sure that we have information that highlights that with the idea being.

I think of it simply, would someone with a chronic migraine potentially need more care than someone without a chronic migraine? I would say probably yes. The important is that there’s new codes. Are there major oh my god, earth shaking? No. But if you treat migraines, certainly this is something you wanna update to make sure do I have the most accurate code?

Now? What about other codes? They did have some code updates to Parkinson’s. You think Sam, what do I care about Parkinson’s? I won’t say there’s probably a direct correlation for chiropractic treating Parkinson’s, but if you have a patient with Parkinson’s, are they more complicated to treat due to their posture, their tendency to fall and stumble?

I. Are they gonna have more back pain? I would say the average person with Parkinson’s does have back pain. Now again, the back pain is probably a factor related to it. This would be probably a comorbidity, but do we need to really update this? Not really. You know what I want in your chart notes? Talk about the Parkinson’s.

There’s stoop posture. This just updates that. Parkinson’s now is just simply gone a little bit more complete. Before we had a single code that said Parkinson’s. There’s variations. Is there one with dyskinesias and fluctuations of movement? That type of issue? It’s gotten more nuanced. Do we really need to be very specific?

I don’t think so, but I will say this, I wanna certainly talk about it. If I have a patient with Parkinson’s, I will guarantee that patient is gonna take longer to get better than a person without Parkinson’s. There’s a complication of comorbidity, let’s face it. Even American Specialty Health, which I know a lot of, you think, oh, I hate that insurance.

I just wish they paid more. I don’t hate them. I wish they paid more, but when you go a pre-treatment authorization, they do pay attention to. These type of complications and comorbidities as to why this patient may need 12 visits and not six visits. Let’s say there’s also some new codes for osteoporosis, and you think there’s already a lot of codes.

Here’s what was interesting though. They never had age-related osteoporosis to the pelvis. They named a lot of other bones, so they added ’em in there. Now, is that an important one for us? Maybe. If a person has osteoporosis, should we know that? Should we be aware? Because maybe we may not wanna manipulate in that area if that bone is very soft, it could be, resulted in a fracture.

So something to keep in mind. Now, here’s what I’m pointing out. White Sam, you gave me migraine codes. Okay, those are new and updated, but Parkinson’s and osteoporosis are those ones that I’m really gonna need or use. As I noted, probably not to some extent, but as a comorbidity, here’s what’s important.

Do you have the proper codes when it comes to making sure you’ve identified what’s wrong with the patient in the best way possible? By example, would I just wanna say headache? If someone has a migraine, headache would be accurate. But would chronic migraine be better and identify why this patient needs more?

One of the biggest complaints I get as an expert dealing with you and dealing with insurances and payments, dealing with boards and otherwise, is I am not getting the care plan that I expected. And I always first look at, did you give a diagnosis for that? So start to look at your diagnosis to make sure that’s how you communicate.

Realize no one looks at your chart notes for the most part. What do they look at the conclusion in the notes. If you order an MRI, you know what you really care about? The outcome. What did the M MRI show? You don’t care that it was AT one weighted image taken in the Sagal and coronal plane. That’s fun.

But at the end of the day, what do you need to know? Conclusion. Always think of. Diagnosis is your conclusion. There are some new codes this year, and I will say this. They code everything. If you’ve ever had a friend that works in a hospital, emergency room or something, do you ever hear those stories of how, oh my God, someone came in, we have an X-ray, and someone had, God knows what inside their body.

There’s actually new codes this year. They’re in the W section for foreign bodies entering a natural orifice. So you can use your imagination. Think of how many natural orifices that we have. I’m going to say four mouth ears. You know where, anyway, look at this. Batteries button. Battery plastic objects. So realize they’ve literally made a code for everything going in.

Here’s what I’ll point out. There are a lot of codes and though someone’s gonna say there are a whole bunch of new codes, do you really care if someone stuck a audio device into a natural orifice? And I’m not saying no to that, but yeah, I’ve just point out that sometimes people get over zealous, you know what?

I care about the things that affect us. Think neuro musculoskeletal when it comes to insurance and just think of treating what chiropractors can benefit a patient for. The better you are at communicating that regardless of insurance, the better you’re gonna have in making sure you can demonstrate what your care plan is doing.

Chiropractic is a phenomenal service. We are doing things that we always said we could. We’ve now have more evidence of it, hence why you’re seeing greater and greater benefits. But don’t feel stuck with, oh, I have to do insurance. No, I’d say you’re gonna do something. But you wanna just make sure you’re out in the broad world.

I have a friend I went to chiropractic college with, he treats bedwetting. He charges only for cash. He’s very busy with it ’cause he doesn’t treat little kids. He treats, 10 and 11 year olds and he has a whole regimen of diet and adjustments, only cash, and he gets paid for it. Does he use the code for Anur?

Resis He does. Or anur? Resis, absolutely. So keep in mind what you’re coding is what you’re seeing. Are there new codes for this year? Yes. Are there enough to make me go there earth shattering? No, but I always like to be up to date. ’cause if you treat headaches, should you know all the codes for migraines?

Absolutely. ’cause there’s a lot of different ways to see it. So please make sure you always have those updates. We’ll be doing seminars first of the year that we’ll update that. Plus CPT as we know we’re changing. And here’s the thing, do you have a good code list? How many of you have an actual good neuro musculoskeletal code list?

HJ Ross offers it. We give it to our members. We do it at our seminars. Take a look. We offer a service where I become part of your staff. I help you out a little bit every day. Make sure you always have a resource. ChiroSecure. HJ Ross, we’re your partners in success. .

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