ICD-10 Update for October 1, 2018
By David Klein, CPC, CPMA, CHC
The 2019 ICD-10-CM diagnosis code changes that go into effect October 1, 2018 are fairly straightforward for Chiropractic offices. The number of changes are significantly less than the prior two years which makes me believe we’re getting back to normal levels of expected yearly changes. For the past two years, the amount of additions and revisions were fairly extensive. After the 2019 updates, we are up to 71,932 codes! The changes this year are as follows:
- 473 code changes
- 279 new,
- 51 deleted,
- 143 revised codes
The good news is that only a handful of these codes really affect the typical Chiropractic office. That being said, everyone should understand that utilizing the right diagnosis codes is more important to your revenue than ever before. If you don’t correctly incorporate each of the new, modified and deleted 2019 diagnosis codes you could be subject to delays and rejections when it comes to getting paid. Most of the changes, provide more specificity than in existing codes. For example, most of the deleted codes are replaced with multiple new codes to specify not just laterality but location, as well.
ICD-10 Code Changes
The key for Providers to realize is that if they use a code that has been deleted or a code that has been changed, they will receive denials and resulting reimbursement delays. Some revisions are as simple as a singular word change in the code, like from “of” to “due to.” Others reflect a change in the medical terminology. The addition of a word may change your use of that diagnosis code. Other changes involve changing one code and the addition of new ones in its place to describe more specificity.
The only significant change for Chiropractic is the ICD-10 code for Myalgia – M79.1 (Chapter 13). This code has been updated and now requires a 5th digit to describe with more specificity. There are 4 new codes that will need to be used instead, as follows:
- 10 Myalgia, unspecified site
- 11 Myalgia of mastication muscle
- 12 Myalgia of auxiliary muscles, head and neck
- 18 Myalgia, other site
If a provider were to use M79.1 on October 1st, it would be denied as being truncated as it only has 4 digits and would require the 5th to be considered valid.
Additional changes likely to affect Chiropractic Providers:
Chapter 6 (Diseases of the Nervous System) includes changes to muscular dystrophy and updates to Pain, not elsewhere classified.
Chapter 20 (External Causes of Morbidity V00-Y99) has updated some of the transportation and accident codes, and added Overexertion and strenuous or repetitive movement as a new diagnosis and Activity diagnoses such as snowboarding, skiing, etc.
Steps All Providers Should Take
- Download the Tabular Addenda for 2019 from CMS located at: https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html
This website will open a page direct from Medicare that will allow a user to download the changes. Providers can select the zip file named “2019 Addendum ZIP”. After opening the zip file, select the PDF document labeled “icd10cm_tabular_addenda_2019”. This file contains all the changes for every chapter.
- Continue to avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. Check the coding on each claim to make sure that it aligns with their clinical documentation.
- Determine which codes affect their practice and review the clinical concepts behind any new codes. Many of the changes should not significantly change your documentation protocols however new codes should be reviewed.
- Update your software/EHR and make sure that the new codes will be available by the deadline. Some vendors will add them automatically while others may require providers to enter the codes into the system manually.
- Remember, on and after October 1, providers should select the codes based on the date of service, not based on the date the claim is sent. Claims for dates of service prior to October 1, 2018 will use the 2017 version regardless of when the claim is sent.
The updates coming October 1 should not have a big impact on your office, as long as you take some simple steps to prepare. It is clear that the expectation is specificity and documentation accuracy.