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ICD-10 Coding Updates

ICD-10-CM diagnosis codes are updated each year on October 1, and this year is no exception to the rule.

This year’s changes will not impact most chiropractors as much as some of the ICD-10-CM updates in the recent past did. However, thanks to a valued colleague of ours here at KMC University, this synopsis highlights a few revisions that may be relevant to chiropractic clinicians, coders, and billers. Providers who are aware of these changes will be able to describe some patients’ conditions with greater detail. In other instances, an understanding of these updates may enable providers to avoid using outdated or inappropriate codes that could lead to denied or rejected claims. You can also check our Kathy’s HelpDesk Q&A Video here for more info!

This information is for educational purposes only and is not intended to replace official coding resources. The Centers for Medicare and Medicaid Services (CMS) provides a cost-free version of the complete, official code set here. Providers should also consider any relevant coding guidance, statutes, regulations, payer-specific policies, or contractual obligations that apply to each encounter. KMC University members can find all the ICD-10 training in the library here, including the publications from CMS noted above.

Category M51 holds six new diagnosis codes to describe lumbar and lumbosacral annulus fibrosus defects.

When reporting these codes, providers must identify the size of the defect as “large”, “small”, or “unspecified size”. As with all “unspecified” codes, providers should avoid the “unspecified size” codes whenever possible. The coding guidance also clarifies that if both a disc herniation and an annulus fibrosis defect are present, providers should report the disc herniation code (M51.06, M51.16, M51.26, M51.17, or M51.27) first. They can then report the annulus fibrosis defect code (M51.A0-M51.A5) after the disc herniation code to provide additional details. The following table lists the new codes.

New Code Code Description
M51.A0 Intervertebral annulus fibrosus defect, lumbar region, unspecified size
M51.A1 Intervertebral annulus fibrosus defect, small, lumbar region
M51.A2 Intervertebral annulus fibrosus defect, large, lumbar region
M51.A3 Intervertebral annulus fibrosus defect, lumbosacral region, unspecified size
M51.A4 Intervertebral annulus fibrosus defect, small, lumbosacral region
M51.A5 Intervertebral annulus fibrosus defect, large, lumbosacral region

Codes in category S06 provide greater specificity related to intracranial injuries.

The category S06 codes require a seventh character of A (“initial encounter”), D (“subsequent encounter”), or S (“sequela”). The updates include the addition of S06.0XA- for “concussion with loss of consciousness status unknown“. While the medical record should ideally indicate if the individual lost consciousness, this unspecified concussion code applies when that information is lacking. Therefore, chiropractors should rarely need this new code to describe a concussion unless the history does not adequately address if the patient lost consciousness.

Category M62 includes new codes to describe “muscle wasting and atrophy, not elsewhere classified, back”.

These new codes provide additional details about the affected spinal region (cervical, thoracic, lumbosacral, or unspecified). Practices that use active rehab with patients will notice that these codes are much more detailed and specific than the prior codes. The following table lists the new codes.

New Code Code Description
M62.5A0 Muscle wasting and atrophy, not elsewhere classified, back, cervical
M62.5A1 Muscle wasting and atrophy, not elsewhere classified, back, thoracic
M62.5A2 Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral
M62.5A9 Muscle wasting and atrophy, not elsewhere classified, back, unspecified site

The M93.0- codes now specify if a slipped upper femoral epiphysis is stable, unstable, or of unspecified stability.

This change necessitated the revision of several codes and the creation of many new codes to identify a slipped upper femoral epiphysis. If a chiropractor diagnoses a slipped upper femoral epiphysis, they can avoid the use of an unspecified code by identifying in the record if it is stable or unstable.

New codes for “other problems related to housing and economic circumstances” included in category Z59 provide additional specificity.

Recent years have fostered an increased emphasis on social determinants of health (SDOH) and their impact on patient outcomes. Codes in categories Z55 to Z65 apply when the documentation shows problems or risk factors related to SDOH. Three new codes reflect the healthcare industry’s growing recognition of the importance of SDOH. The new codes further clarify the nature of the economic circumstances that may impact patient outcomes, thus enabling providers to report transportation insecurity, financial insecurity, or material hardship as a problem or risk factor. The Official Guidelines for Coding and Reporting say that providers should assign as many SDOH codes as are necessary to describe all the problems or risk factors. However, these codes should only be assigned when the documentation specifies that the patient has an associated problem or risk factor. For example, providers should not assign code Z59.82 for everyone who cannot obtain adequate transportation, only when the provider has documented that the inadequate transportation is a problem or risk factor for that patient.

New Code Code Description Includes
Z59.82 Transportation Insecurity Excessive transportation time Inaccessible transportation Inadequate transportation Lack of transportation Unaffordable transportation Unreliable transportation

Unsafe transportation

Z59.86 Financial Insecurity Bankruptcy Burdensome debt Economic strain Financial strain Money problems Running out of money

Unable to make ends meet

Z59.87 Material Hardship Material deprivation

Unable to obtain adequate childcare Unable to obtain adequate clothing Unable to obtain adequate utilities

Unable to obtain basic needs

Overall, this was a mild year for ICD-109 changes for the profession. Be sure to make these changes to all documents used for diagnosis coding, including your software, to stay ahead of potential denials.


References:

  1. (2022). 2023 ICD-10-CM Expert. AAPC.
  2. The Centers for Medicare and Medicaid Services (CMS) & National Center for Health Statistics (NCHS). (2022). ICD-10-CM Official Guidelines for Coding and Reporting FY 2023
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