Chiropractic Billing Strategies in Light of ICD-10 Amendments

Did you know? The correct application of ICD-10-CM codes in chiropractic practice is crucial for detailing the specific conditions being addressed during patient visits. These codes not only aid in comprehensive documentation but also contribute to the continuity of care by enabling effective communication among healthcare providers.

In fact, the ICD-10-CM code set undergoes regular updates and changes to reflect advancements in the chiropractic/medical field, changing diagnostic practices, and emerging health trends. Chiropractors must stay informed about these code changes to ensure accurate and up-to-date reporting of patient conditions. Let’s have a glimpse of all these changes meant for chiropractors:

ICD-10-CM Code Changes for Chiropractors

• Limb Girdle Muscular Dystrophies (LGMDs) – G71.03

Now, specific codes reflect the genetic variants causing LGMD, emphasizing the need for accurate documentation and coding by chiropractors.

• Lumbar and Lumbosacral Intervertebral Annular Fibrosis Defects – M51.A

While mainly intended for tracking surgical outcomes, these codes emphasize the importance of coding disc herniation alongside annular defects.

• Muscle Wasting and Atrophy Expanded – M62.5

Chiropractors must note the inclusion of specific codes for cervical, thoracic, lumbosacral, and unspecified regions.

• Changes to “Slipped Upper Femoral Epiphysis (Nontraumatic)” – M93.0

New inclusion terms, the addition of stability indicators, and sub-categories like “Unstable” and “Acute” underscore the need for careful review.

• Chronic Fatigue Changes – G93.3- and G93.32

Now, these codes are classified as “Myalgic encephalomyelitis/chronic fatigue syndrome,” importantly, an instructional note is added regarding post-COVID-19 conditions.

• Concussion Changes – S06.0X- and S06.0XA

Updates to the S06.0X subcategory for concussions bring new inclusion terms, and the addition of S06.0XA is for cases where the loss of consciousness status is unknown.

• e-Bike Injuries – V20-V29

Notably, injuries related to electric bicycles now have distinct codes, differentiating them from conventional motorcycles.

Keeping in mind these changes, there is a need to make efforts in the form of chiropractic billing strategies to ensure smooth and correct billing and coding for chiropractic services. In fact, these billing strategies play a crucial role in providing accurate reimbursement for chiropractors’ services. With the implementation of the International Classification of Diseases, 10th Amendment (ICD-10), the key billing strategies that can be opted for include.

• Comprehensive Documentation of Initial Treatment

Efficient chiropractic billing begins with comprehensive documentation of the initial treatment. Chiropractors should provide a detailed record of the patient’s history, examination findings, and treatment plan. This documentation serves as the foundation for accurate coding and billing. Including information about the patient’s main complaint, history of current health status, and any relevant past medical history is essential for establishing medical necessity.

• Specifying Spinal Location and Subluxation Level

ICD-10 emphasizes specificity, and chiropractors must document the precise spinal location and level of subluxation. This includes identifying the affected vertebra or joint and specifying whether the subluxation is cervical, thoracic, or lumbar. Accurate documentation helps prevent claim denials and ensures that the billed services align with the patient’s diagnosis.

• Reporting the Date of the X-ray

When X-rays are part of the diagnostic process, chiropractors should document the date of the imaging study. This information supports the medical necessity of the X-ray and helps justify the need for chiropractic adjustments. Including the X-ray date in the documentation aids in demonstrating the chronological progression of the patient’s condition and contributes to the overall integrity of the billing process.

• Utilizing Appropriate ICD-10-CM Codes

Chiropractors must select the most accurate and specific ICD-10-CM codes to reflect the patient’s condition. The ICD-10-CM code set provides a comprehensive range of codes for various neuromusculoskeletal conditions. Proper code usage ensures that the billed services align with the documented diagnosis, reducing the risk of claim denials and facilitating accurate reimbursement.

• Listing Subluxation Level as Primary Diagnosis

Chiropractors should prioritize the level of subluxation as the primary diagnosis when submitting claims. This aligns with the core focus of chiropractic care and helps insurers understand the primary reason for the patient’s visit. Proper diagnosis sequencing enhances the claim’s clarity and contributes to timely and accurate reimbursement.

• Listing Neuromusculoskeletal Condition as Secondary Diagnosis

Incorporating the neuromusculoskeletal condition as a secondary diagnosis complements the primary subluxation diagnosis. This dual-diagnosis approach provides a comprehensive view of the patient’s condition, allowing for a more accurate representation of the services rendered. It also supports the medical necessity of chiropractic care by linking the subluxation to the broader context of neuromusculoskeletal health.

Impact on Chiropractors

Adopting these chiropractic billing strategies in accordance with ICD-10 amendments has significant positive implications for chiropractors. Accurate documentation and coding enhance claim acceptance rates, reduce the likelihood of audits, and promote overall practice efficiency. By aligning billing practices with ICD-10 standards, chiropractors demonstrate a commitment to quality care and compliance, fostering positive relationships with insurers and improving revenue rates for their practices.

But are you short of time to apply all these chiropractic billing strategies?

Now, you can effectively streamline the implementation of ICD-10-CM code changes by outsourcing your billing and coding operations to specialized professionals such as 24/7 Medical Billing Services. Outsourcing will allow you to leverage the expertise of billing and coding specialists who stay current with the latest updates and ensure accurate application of codes, reducing the risk of errors and improving compliance. This approach will also enable chiropractic services to focus on patient care while seamlessly integrating ICD-10-CM changes without the burden of extensive administrative tasks.

See also: Preserving Patient Trust: The Impact Of Proper Billing In Chiropractic