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Chiropractors will face significant medical coding changes in 2023. These changes include the introduction of 1176 new codes, 28 revised codes, and the removal of 287 codes under ICD-10. Additionally, new codes for lumbar and lumbosacral disc disorders, spinal muscle weakness and atrophy, among others, will be introduced for chiropractors. Changes to coding and documentation for E/M services will also affect chiropractors in 2023. To navigate these changes, chiropractic coding companies can assist practices in submitting accurate claims and streamlining their medical billing and coding processes.
Significant ICD-10 Code Updates Relevant to Chiropractors in 2023:
New codes have been introduced for identifying annulus fibrous defect (disc) of the lumbar and lumbosacral spine, which are lower back conditions. These codes are part of the updates to the ICD-10 codes and are intended to provide more specific diagnoses for these conditions:
M51.0 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with myelopathy
M51.1 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with radiculopathy
M51.2 Other thoracic, thoracolumbar and lumbosacral intervertebral disc displacement
M51.3 Other thoracic, thoracolumbar and lumbosacral intervertebral disc degeneration
There are 7 new codes for reporting annular defects in the lumbar and lumbosacral regions:
M51.A Other lumbar and lumbosacral annulus fibrosus disc defects
M51.A0 Intervertebral annulus fibrosus defect, lumbar region, unspecified size
M51.A1 …small, lumbar region
M51.A2 …large, lumbar region
M51.A: …lumbosacral region, unspecified size
M51.A4 …small, lumbosacral region
M51.A5 …large, lumbosacral region
New codes have been introduced to specifically identify spinal regions affected by muscle wasting and atrophy:
M62.5 Muscle wasting and atrophy, not elsewhere classified, back
M62.5A9: …unspecified level
The coding for concussions has been updated to include a new subcategory, S06.0XA, which identifies a concussion with an unknown loss of consciousness:
S06.0XA- Concussion with loss of consciousness status unknown
S06.0XAA …initial encounter
S06.0XAD …subsequent encounter
Slipped Upper Femoral Epiphysis (Nontraumatic) is a condition that affects adolescents and causes the femoral head to slip in relation to the rest of the femur due to damage to the growth plate, while the head of the femur remains in the hip joint cup:
Effective October 1, 2022, the Slipped Upper Femoral Epiphysis (Nontraumatic) (M93.0-) code set was expanded to include more diagnoses. The following are some of the changes:
The expanded M93.0-code sets provide more options with five or six characters, which can specify the severity of the epiphysis condition as unspecified, acute, chronic, or acute on chronic.
There are many codes that indicate laterality.
A new category of M codes has been added to identify sternum and rib fractures that are associated with chest compression and cardiopulmonary resuscitation.
The term "stable" has been added to M93.01-, M93.02-, M93,03- codes.
Post-viral fatigue syndrome:
A new code, G93.31, has been added to identify post-viral fatigue syndrome. Patients with this syndrome may have difficulty recovering from common chiropractic conditions, and insurers often require identifying complicating conditions and comorbidities in claim documentation, as per an article on dynamicchiropractic.com.
ICD-10 uses the letter "V" to indicate an external cause, and injuries caused by e-bike accidents are reported separately from those caused by motorcycle accidents under codes V20-V29. The codes for e-bike injuries have been expanded.
V20.2- Unspecified motorcycle rider injured in collision with pedestrian or animal in nontraffic accident
V20.91XA: Unspecified electric (assisted) bicycle rider injured in collision with pedestrian or animal in traffic accident, initial encounter
V21.51XA: Electric (assisted) bicycle passenger injured in collision with pedal cycle in traffic accident, initial encounter
Stay Up to Speed on E/M Coding Updates
The American Medical Association (AMA) has updated the CPT Evaluation and Management (E/M) Code and guidelines, which will be effective from January 2023. These changes build upon the revisions made to the E/M office visit CPT codes (99201-99215) code descriptors and documentation standards in 2021. The updated guidelines are aimed at focusing documentation of E/M office visits on how physicians think and take care of patients, instead of mandatory standards that encourage copy/paste and checking boxes, according to the AMA.
The E/M updates aim to reduce the administrative burden for physicians across various specialties. They simplify the coding process for E/M services and offer more flexibility for chiropractic billing services. For codes 99202-99205, the level of MDM or total time spent during the encounter determines code selection. Chiropractors can use add-on code 99417 for services lasting more than 74 minutes. It is important for providers to be familiar with the essential CPT codes for chiropractic services, 98940-98943, and to ensure appropriate clinical documentation.