The official ICD-10 updates for Fiscal Year 2022 go into effect October 1st, 2021. There were 211 code changes (159 new, 25 deleted, and 27 revised) and there were updates and clarifications to some guidelines. As in the past, only a few of these changes are relevant to chiropractors and other physical medicine providers. To see the complete list of changes, go to https://www.cms.gov/medicare/icd-10/2022-icd-10-cm. Consider the following:
G44.86 Cervicogenic headache
This code includes the instruction: “Code also associated cervical spinal condition, if known
M54.5 Low back pain
M54.50 Low back pain, unspecified
M54.51 Vertebrogenic low back pain
Low back vertebral endplate pain
M54.59 Other low back pain
At first glance, vertebrogenic low back pain may appear to be a good option for chiropractic, however, this condition will likely need to include diagnostic evidence of endplate damage, as visualized on MRI. In other words, M54.50 is probably the best option to replace what was previously reported with the now deleted code M54.5.
All ICD-10 changes are automatically updated for PayDC and APS clients. However, you will need to add them to your “included” codes in the advanced settings if you want them to be visible in your SOAP notes or Care Plans. Check out https://paydc.com/paydcsupport/advanced-settings/functional-preference/care-plan/icd-10/ for a refresher on how to do that.
A few changes made this year to the ICD-10 guidelines also have relevance to physical medicine providers.
General Coding Guideline No. 13 has this guidance added:
When laterality is not documented by the patient’s provider, code assignment for the affected side may be based on medical record documentation from other clinicians. If there is conflicting medical record documentation regarding the affected side, the patient’s attending provider should be queried for clarification. Codes for “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side and it is not possible to obtain clarification.
Under Guideline No. 18, Use of Sign/Symptom/Unspecified Codes of the General Coding Guidelines, there was a new paragraph added to the guidance:
As stated in the introductory section of these official coding guidelines, a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation, accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.
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