Blog, Live Events October 27, 2021

Identify and use the new ICD10 Updates

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Hi everyone. This is Sam Collins, your coding and billing expert for chiropractic and the HJ Ross Company. Welcome you to another episode with ChiroSecure to always keep you up to date. Always making sure your practice can continue to grow and to make sure your claims get paid. I’m the coding and billing expert. So therefore, what do we always like to discuss coding and billing? And of course, what really comes down to payment as you’re well aware, and I’m sure you’ve already seen it. The codes for back pain I’ve updated, but what are these new updates mean? What are the new codes codes? What is the best utilization and actually, should you even use back pain? And is there anything else that’s changed? What ChiroSecure and the HJ Ross Company are always here to make sure that your changes or the changes are always something you’re made well aware of.

So let’s go ahead and get to the slides, get right to the point, if you will. So let’s move forward here. And oops, I went too fast. This is going to be the update. That’s a chiropractic primmer. You know, we’re going to be very Chirocentric. What do I care about the things that occur for Kairos? So what’s going on of course, October 1st is when the changes updates. So this is where I think a lot of confusion comes in because people wonder, well, when did the 2022 codes begin? Well, they actually began October 1st of the year before, which has been true for every year. There’s been an update even before ICD 10. So always keep in mind. The date of change is October 1st, but what’s important to know is when do I use these and how do I use them? Because what if I see a patient on September 30th or earlier?

And then I bill it sometime in October or November, if the date of treatment is before October 1st, you will continue to use the old code. If the data treatment is after the new code. So for the first month, there’s often a lot of confusion about this because which one should I use? So make sure you don’t combine dates of service that are before or after. They have to be separate claims, but I would assume probably you’re billing out fairly timely. So everything right now should likely be with the new codes. Keep in mind though, if you’re rebuilding an old code, make sure to have the old code. If the data service was before October 1st, however, I’ve had some calls in the city, Sam I’ve got denied. Well, what I will tell you is I’ve never seen a denial from the insurance, but what I’m seeing a lot of is your clearinghouse has your clearinghouse is sometimes aren’t up to date and there’s nothing more frustrating to me.

Then you’re trying to build correctly in the people that should be doing it and stay up to date art. So check with your clearinghouse if you’re getting a rejection, because that’s likely not the insurance. Well, as I’ve mentioned every year, there’s updates and you’ll see here, there’s a lot of codes some years. And this dates back to the first update in 2017, were there some years like 2,360, but the truth is we want to care about what’s changed for us. So by example, last year, everyone goes, well, what were the code changes? The reality was what were the code changes last year that were significant to chiropractic for the most part, those headache codes, you know, the [inaudible] to our 51, 0 and nine. So even though there were 490 additions, it was really only two that applied to us. Well, what about this year? This year, we look at the codes and go, okay, well now there’s 72,748 codes, 159 additions, 32 deletions.

Here’s just the truth. You’re going to focus in again on what is specific to chiropractic regardless of 72,000 codes. None of you are using that many. In fact, I bet if I go through your offices and I teach continuing out across the U S I would say the average chiropractic office probably uses no more than 15 or 20 codes on a regular basis. And of those 15 or 20, there’s probably less than 10 that are very regular. So what we care about is making sure do I have the codes that I’m using have any effect on what’s happened? Well, this year is a big one because low back pain is updated. Now, low back pain. The code was M 54 5. That’s now been updated to three new versions, but let’s talk about what is lower back pain, the approximate cinemas for lower back pain, what you think it is.

It’s just back pain. Acute chronic could be related to pregnancy with radicular apathy mechanical, or we’ll say lumbago or groin pain. My statement to you would be, I would recommend not using back pain. If you have a better code to describe the pain, it will give a better relationship of what you’re treating, as opposed to just saying back pain. Would it be better to say lumbar sprain or strain? I would say certainly however back pain is still a good code. It’s viable, particularly if it’s a very mild or simple problem. So for this year, what we’ve updated now is M 54 50. It goes to the low back pain unspecified. So that’s kind of your generic, I don’t know what’s causing it code then there’s M 54 51 for vertebro genic. Now, when I first saw that I was excited like, oh, something related to the spine, it sounds very chiropractic.

We’ll talk about that. Cause it’s not as much as you might think, but nonetheless says for T progenic then the third one is M 54 59, and that is the code for other. Now, most people go well, what does other mean compared to unspecified? Well, we’ll go through the details of that to make sure there’s a good understanding of why you would use any one of these codes or maybe the better code might be available. Well, let’s talk about first, the unspecified and low back pain unspecified says non-specific low back pain is defined as low back pain, not attributable to any recognizable, known specific pathology. So in other words, what you’re really saying with M 54 50, let’s be clear is there’s back pain. And I don’t know why. And my rule would be as a doctor of chiropractic. I kind of hope, you know why. And of course that’s what I would diagnose pain is almost always there when you don’t know the underlying condition, like there’s pain there, but I don’t know why.

So for me, this wouldn’t be what I would use. Cause I would assume there’s something else that’s causing it that you could code could be as simple as spondylosis, radicular, apathy, all those types of things could be there. It’s still a viable code. Here’s what’s important. If you were using back pain, M 54 50 is a code for just saying there’s back pain, but you’re not giving any real description of why there’s back pain, but just back pain. Well, how about this one in 54, 51 vertebra genic, low back pain vertebra Magenic pain is specifying the origin of pain from the vertebra or the spine. Now that may be very chiropractic. You’re like, Ooh, that looks good. However, this code is to distinguish specifically lower back vertebral endplate pain. So the reason this code actually became a code is they wanted a code to describe vertebral endplate plane.

I would have suggested they probably should have just called it that, but nonetheless, be careful. This code is not for saying, oh, there’s something related to the spine, such as a sprain or a strain, anything of that nature, this means literally from the bone itself. And so I would say not that it’s a code you couldn’t use it probably likely would not be typical. Okay. You would need a covered specific specificity towards that. It is vertebral in-play pain. So I would say not luckily one we would use so sparring, bloody cousins conditions like sprain strain. There’s a code for it. So same for T progenic again, I want to focus means coming from the bone itself. Well, what about this other code? Other? So we have unspecified in other well, other means you can name it, but it doesn’t have its own specific code. By example, if you ever heard of the condition Fossette syndrome, I would make an argument that this code could be used for Fossette syndrome because you can name what it is, but there is no specific code for it.

By example, if you looked up Fossette syndrome, if you went all throughout the code system to look for it, you actually wouldn’t find a code that literally says Fossette syndrome. So how do I code that? Well, using a code like this would do so because you’re able to specify it’s Fossette syndrome. However, I would recommend not because there’s a better code, that’s called other specified Dorsa apathy’s, which would be for lumbar spine, M 53 86. So always kind of look a little bit better, be it more of a student of coding. I’m not saying these codes are wrong, but they just describe a simple symptom. And if you’re describing a simple symptom, there’s intended that there’s a simple recovery. Well maybe the employee pain, a little bit different, but nonetheless they’re expecting not very many visits. So I’m going to say from a best practice standpoint, what should I do?

And 54 50 or 54 59 would be the best option for a chiropractor provider to just simply code back pain, unknown reasons, 50 known reasons, 59. But I would go, if you have known reasons, why do you use a 59? Why don’t you have the known reason? The best practice in my opinion is to not code pain, but called the reason what is the reason for the pain? Is it a sprain? Is it a strain? Is it ridiculous? Apathy, if you indicate radicular apathy, do you have to tell me it’s painful? Well, I guess you could, if you want, but I would suggest re you know, radicular apathy with pain, the pain adds nothing to the equation. By example, if you serve saw just ridiculous apathy, what would be the number of visits you think a person would need compared to ridiculous coffee with pain? Well, could you have ridiculous without pain, I guess, but you kind of get my point focusing on the reason more than the symptom.

Not that the symptom is necessarily the wrong, but one thing I’m going to make important here. It says you may not code low back pain spot or low back spine pain with lumbar disc. So be very conscientious. This is called an exclude. And I see this come up quite a bit. I do a lot of consulting seminars and one-on-one with you. And I often get Sam, my claim got denied. And what they’ve done is they’ve included back pain with lumbar disc. And I want to make clear to everyone. You cannot code spine pain with a disc code. In fact, I would say, why are you telling me it’s painful? Isn’t disc automatically sort of that it will be akin to. If you coded an ankle sprain, would you go, oh, I better tell them. It’s also painful. Pain is kind of inherent. So understand pain codes are mostly when there’s pain and you don’t know why.

If you have the Y diagnosis, you don’t have to tell me is painful, but do be clear on this. If you were to code lumbar disc with a spine pain code, the claim is rejected because it’s a, it’s an exclude. You may also not code pain with lumbar strain. Now that’s kind of weird, but that’s sort of makes sense. It’s either a strain or you don’t know why and it’s pain. So you get kind of that unspecified, if you will. So focus in on the specificity. You think of it. If I tell you sprain, what is the connotation of the number of visits and care plan compared to if I just say pain, pain is kind of like the one, I don’t know why it’s there. It’s just hurting. Now. If you’re going to treat someone for a few visits, I’m all in. But if you’re going to treat more than a few visits, I want a reason behind that care plan.

Now, what else has changed for this year, though? There is a new code. This is brand new. There’s a new code for a cervicogenic headache. Now notice most of you are going, I didn’t know that change because everyone focused on back pain. We always want to look a little deeper HJ Ross in our seminars. We focus on them. Here’s the new code G as in George, 44, 86. Now cervicogenic headache for the first time. Now has a code before you had to use the other specified and kind of later say, it’s cervicogenic. Now they realize no can the neck cause headaches. In fact, it’s a secondary headache to the neck. In other words, the neck is the problem, but the perceived pain is usually in the head typically associated with reduced range of motion and pain. So again, it makes a lot of sense. It gives me a little bit more specificity than just saying headache.

And I want you to think along these terms, could you have a patient that has a migraine and still call it a headache? Could you have a person with a cervical genic headache and still call it a headache? But think of, if you say cervicogenic compared to headache, it’s more specified and generally is going to give a little bit better reason for the type of care, length of care. There’s some other updates as well. All these aren’t really as critical. In fact, most years there’s lots of updates had nothing to do with us. By example, though, I think we’re all familiar with Sjogren’s syndrome. Now Sjogren’s syndrome has always had a code. However, the code always indicated sicca syndrome, which was for the correct conjunctivitis. And of course Sjogren’s syndrome is often associated with things like rheumatoid arthritis. Now, is this a primary reason for care?

Probably not, but at the same token, could it be a complication or comorbidity? Absolutely. There’s also some new codes that I think a lot of people may not have seen. They’re called non-radiographic spondyloarthritis. So in other words, they’re spondylitis spondyloarthritis or significant arthritic changes, but on x-ray it’s not really imaged now. So this doesn’t mean you’ve taken an x-ray and or that you didn’t take an x-ray and there’s arthritis. This is literally, there’s an arthritic problem and symptoms, if you will, but no discernible major arthritic problems that you can see on the films. And there’s a condition for that. And that’s why they updated those codes. Now, would that be a code we use very often may or may not, but I always think of it as a complication. Is arthritis alone, a reason for care? No, everybody has arthritis, but when arthritis is very painful, then I was suggested would be.

So now that’s a situation where I might code spondyloarthritis or excuse me, arthritis of the spine with pain to indicate there’s significant amount of pain associated. So again, that’s maybe where a pain comes in, but anyway, there’s a new code now, even on x-ray when it doesn’t show, but it’s still present with the signs and symptoms. Also, there is a new code for headaches. I shouldn’t be for headaches. I said that already makes you a new code for cough. Now you might think San Marino cough. Well, cough is not something that we would obviously treat. It’s not part of the chiropractic realm, if you will, for neuromusculoskeletal, but they’ve added some codes to distinguish the cough for things like acute subacute, chronic and so forth. But here’s why I bring it up. Not so much that you’d ever use it. What if your patient has significant coughing while they have back pain?

While I may not code it directly? I want to document that because a lot of coughing or that fecal pressure, if you will, will that irritate back pain, neck pain or pain just about anywhere. Absolutely. So I want you to always think of when you’re diagnosing, am I giving the fullest picture of my patient? Because if you’re saying my patient needs 20 visits, I’m all in, but does your diagnosis equal? That is 20 visits. That’s the critical part. So remember for diagnosis, chiropractors are paid for neuromusculoskeletal conditions. Now I’m not saying you can’t code and treat a lot of things. I’m talking from insurance reimbursement it’s neuromusculoskeletal. So do pay attention. Most insurances produce list of codes that they do, and don’t allow types of codes, for instance, Aetna, Cigna, and others. And if you use a code that’s not on the list like Medicare, the claim will be denied.

By example, I’ll throw one out. If you were to code Aetna insurance, a thoracic strain code [inaudible] it would be denied. So it’s an important to note that always know not only neuromusculoskeletal, but what codes are on the list? Well, that’s one of the things we do with our company. We always want to update you. So here’s a, just a quick note from our site, our new section at HJ Ross company update you on what’s new and what’s happening. And you’ll see here, we updated in September, the new codes. Cause think of it. Where are you getting your updates from? Do you have someplace to go? That always gets you there. Members of our service always can be updated. So take a look at our company, go to our site. We’re here to help. We partnered with ChiroSecure to make sure you’re getting paid. If your claims are being denied and you’re going, oh my God, what’s happening with CPT for the new year? What other codes have changed? Or what’s the best code or, oh, what’s the other exclude Sam. We’re here to help you in that way. So HJ Ross is always going to be your resource. I appreciate you all. And next week’s guest will be mark student pay attention. Otherwise, thank you very much, everyone. I’ll see you next time.