Chiropractic Coding in ICD-10-CM
Just like many medical professionals, Chiropractors are also concerned at the work that ICD-10 will create for their practice. ICD-10-CM is providing Chiropractors with more specific codes which will help in reducing claim denials and provide for accurate reimbursement, unlike the limitations in ICD-9.Medical coders for a hospital or general medical practice will be benefited as the number of codes are immense, which will help in learning when the ICD-10 transition occurs in October 2015.
The ICD-10 Impact: Changes to Chiropractic Coding
ICD-10 coding is mandatory, no matter what field of medicine a healthcare professional practices . The codes will be changed and the medical practitioners should be able to comply, which means Chiropractic physicians are not exempt. Some of the changes that Chiropractic Physicians must know is :
- There will be about 200 codes commonly used by Chiropractors that are affected by the transition from ICD-9 to ICD-10.
- There will be a diagnosis hierarchy in Chiropractice Coding :
Neurological,
Structural,
Functional and
Soft tissue will take coding precedence.
For example, sciatica being a neurological disease, will be considered first over degenerative disc disease , the latter being structural disease.
- Wherever applicable, chiropractic coding will also require specificity of laterality, which means the diagnosis code turns into a combination code, unlike ICD-10.
Some of the other changes are:
- All the diagnosis codes will be changed in ICD-10 : 739 and 839 series subluxations will be changed in ICD-10.
- There would be a need in change in documentation due to specificity in ICD-10 : Greater accuracy is one of the primary reasons ICD-10 is promoted for. So it will be obvious that, documentation will also need to change to reflect that specificity. For example, many ICD-10 codes contain codes describing right or left side. So the coding shall be for the specific side, muscle and/or anatomical location. If the documentation doesn?t contain the required level of specificity match up, then as a natural consequence denying the service will surely occur.
- Training for both Physician and Staff in ICD-10 : ICD-10 will require lot of interaction between Physician and your staff because the billing, coding and documentation will be more intertwined. Depending on the size of the practice or the experience level, there will be a need to be trained in proper implementation of ICD-10.
- In ICD-10, There will be no ?exceptions? : The Electronic Clearing House, Insurance Payers and Software have all made conversions to the 5010 format for claims transactions. The 5010 format is a language that simply allows two different computers to speak the billing/coding language and is also the pre-cursor to the ICD-10 changes. It won’t matter how things are billed (via paper or electronically), since ICD-10 will change the actual diagnosis codes that are used. So, ICD-10 would be no exception.
- Expect Reimbursement Delays : At this point, many billing industry experts are being warned by federal entities (like Medicare and Medicaid) and are already behind in their ICD-10 implementation and have performed no ?end to end? testing to check if their systems are actually compatible with the ICD-10 format. Commercial payers are a little better off and have been testing their systems. If payers announce that ICD-10 implementation will cause reimbursement delays, there will be a need of cash to float through those delays. Better to have cash reserves for 3 to 6 months from the start of ICD implementation.
The Bottom Line :
Now is the time to read articles and prepare on ICD-10 and getting informed on what needs to be done. In this respect, future articles, hands-on training via chiropractic seminars can help in the proper preparation of ICD-10 for Chiropractic.