October 1, 2019 the 2020 ICD-10 codes went into effect and PayDC has updated the code-set to include code changes. This year there were 273 new codes, 30 revised codes and 21 deleted codes, bringing the total number of codes up to 72,184. Fortunately, these changes are unlikely to have much impact on the average chiropractor/physical medicine provider, however here are a couple of them to be aware of:
- Guideline Section 1.19.c:
- For physeal fractures, assign only the code identifying the type of physeal fracture. Do not assign a separate code to identify the specific bone that is fractured.
- Code revision:
- Z45.42: “Neuropacemaker” is changed to “neurostimulator” and brain, peripheral nerve, and spinal cord are removed.
We have noticed an increase in payers using some established ICD-10 guidelines to deny claims. Please review the following:
- When a code includes an Excludes1 note, that means that the code that follows cannot be used with it. For example, M54.6 Pain the thoracic spine includes an Excludes1 note for M51– disc disorders. These codes should not appear on the same claim, even though some of the M51 codes are for the lumbar spine.
- Pain diagnoses: Diagnosis codes such as M54.2 Cervicalgia, or M54.5 Low back pain are considered short term and more of a symptom than a definitive diagnosis. Consider identifying the cause of the pain and reporting that more definitive diagnosis instead. Reporting a symptom diagnoses does not do much to establish medical necessity and payers are increasingly scrutinizing providers who routinely use these codes.