Question: Will there be any updates to ICD-10 diagnosis codes this year that will affect chiropractic claims?
This is always a question I welcome, particularly at this time of year. A big reason to become aware of the 2021 new-year changes to diagnosis is that although they are indicated as 2021 codes, they actually update on Oct. 1, 2020, not in 2021. Thus, these updates require that any date of service or billing on or after Oct. 1, 2020, must reflect the new or revised code, or it will be denied.
Considering the annual updates, you are likely aware that some years, the updates create major changes for common chiropractic diagnosis codes. For instance, the first update in 2017 had about 100 codes commonly used by chiropractors. This included updates to the cervical disc codes, sprain and strain of the jaw, temporomandibular disorder codes, and postsurgical pain codes. In 2018, the only significant change for chiropractic was for spinal stenosis in the lumbar spine, which added codes for with and without neurogenic claudication; while 2019 included new and specific code updates for myalgia, postpartum depression and muscular dystrophy.
For 2020, there was a change to vertigo; and multiple additions to foot and ankle disorders, and foot congenital anomalies or deformities. These are not common, as vertigo would likely fall under a complication or comorbidity; and the foot anomalies certainly if related to a foot orthosis.
2021: New Codes for Headache
This year has one change that will certainly affect doctors of chiropractic. The code for headache R51 is being deleted and replaced. Code R51 is (was) the diagnosis code used for headache, with the approximate synonyms being:
- Cervicogenic headache
- Chronic facial pain
- Chronic mixed headache syndrome
- Chronic pain in face
- Craniofacial pain
- Daily headache
- Facial pain
- Facial pain, chronic
- Headache, cervicogenic
- Headache, chronic daily
- Headache, mixed
- Headache, occipital
- Headache, sinus
- Occipital headache
- Pain in face
- Sinus headache
- Sinus pain
It is the most common form of head pain. It is pain in various parts of the head, not confined to the area of distribution of any nerve.
There will be two new codes to replace R51 and the new codes have four characters each:
- R51.0 Headache with orthostatic component, not elsewhere classified
- R51.9 Headache, unspecified
Note: If you place to few or too many characters for a given code, it will be denied as not to the highest level of specificity.
Orthostatic headache is a condition in which a person develops a headache while vertical, and the headache is relieved when horizontal. Previously, it was often misdiagnosed as different primary headache disorders such as migraine or tension headaches. This code was added to differentiate several codes related to intracranial hypotension and cerebrospinal fluid leaks.
Based on this clarification, it is clear that the common headache code replacing R51 would be to use R51.9 headache, unspecified, which would include all the synonyms noted above.
New Codes for TMJ Issues
There are also some less common codes for 2021, but certainly within the scope of neuromusculoskeletal coding for chiropractors, for temporomandibular joint (TMJ) issues. Chiropractors can and do treat TMJ conditions, which include TMJ disorders M26.601 through M26.603; and sprain and strain of the jaw M26.621 through M26.629 and M26.31 to M26.639. However, these new codes do give additional information and specificity for TMJ for arthritis and arthropathy:
- M26.641 Arthritis of right temporomandibular joint
- M26.642 Arthritis of left temporomandibular joint
- M26.643 Arthritis of bilateral temporomandibular joint
- M26.649 Arthritis of unspecified temporomandibular joint
- M26.651 Arthropathy of right temporomandibular joint
- M26.652 Arthropathy of left temporomandibular joint
- M26.653 Arthropathy of bilateral temporomandibular joint
- M26.659 Arthropathy of unspecified temporomandibular joint
Code Changes for Other Joint-Related Disorders
The other new codes involve joint-related disorders for other specified joints. These include:
- M19.09 Primary osteoarthritis, other specified site
- M19.19 Post-traumatic osteoarthritis, other specified site
- M19.29 Secondary osteoarthritis, other specified site
- M24.19 Other articular cartilage disorders, other specified site
- M24.29 Disorder of ligament, other specified site
- M24.39 Pathological dislocation of other specified joint, not elsewhere classified
- M24.49 Recurrent dislocation, other specified joint
- M24.59 Contracture, other specified joint
- M24.69 Ankylosis, other specified joint
- M24.89 Other specific joint derangement of other specified joint, not elsewhere classified
- M25.39 Other instability, other specified joint
- M25.59 Pain in other specified joint
- M25.69 Stiffness of other specified joint, not elsewhere classified
Doctors of chiropractic are not limited to neuromusculoskeletal diagnosis; however, payment of a claim by all carriers including general health, Medicare, worker's compensation, personal injury and VA claims do require such.
How Are ICD-10 Codes Used and Why Are They Important?
- Accuracy of diagnosis in medical records affects patient management and medical necessity.
- Insurance reimbursement for diagnostic testing and treatments is linked to ICD-10 coding.
- Researchers can use these codes to track the incidence and prevalence of each diagnosis, and to assist with outcomes research.
As stated to me as part of the Functional Disability Reference Group for WHO and ICD-11, "For chiropractic to count it must be accounted for." This occurs when chiropractic providers assign both diagnosis and CPT coding so data and outcomes can be detailed and followed as to the efficacy of chiropractic services.
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