icd-10 training for chiropractic

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Dr. Evan Gwilliam

• Education• Bachelor’s of Science, Accounting - Brigham Young University• Master’s of Business Administration - Broadview University• Doctor of Chiropractic, Valedictorian - Palmer College of

Chiropractic

• Certifications• Certified Professional Coder (CPC) - AAPC• Nationally Certified Insurance Coding Specialist (NCICS) - NCCT• Certified Chiropractic Professional Coder (CCPC) - AAPC• ChiroCode Certified Chiropractic Professional Coder (CCCPC) -

ChiroCode• Certified Professional Coder – Instructor (CPC-I) - AAPC• Medical Compliance Specialist – Physician (MCS-P) - MCS• Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS• Certified ICD-10 Trainer - AAPC

Overview• Part 1 - ICD-10 fundamentals and navigation• Part 2 - Coding conventions and guidelines• Part 3 - ICD-10 code selection strategies• Part 4 - Documentation improvement

***Specialty specific training

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1. 739.1 Segmental and somatic dysfunction, cervical

2. 739.3 Segmental and somatic dysfunction, lumbar3. 739.2 Segmental and somatic dysfunction,

thoracic4. 724.2 Lumbago5. 723.1 Cervicalgia6. 728.85 Spasm of muscle7. 724.1 Pain in the thoracic spine8. 729.1 Myalgia and myositis, unspecified9. 847.0 sprains and strains of neck

Top ICD-9 codes for DCs

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1. Use the three strategies to get started1. Common codes list2. GEMs3. Alphabetic Index

2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable.

3. Within the Tabular List, look at the following:1. Notes2. Includes and alternative wording3. Excludes14. Excludes25. Code Also, Code First, Use Additional6. Seventh character extensions

4. Reverse map for confirmation if necessary

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1. Common Codes

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• M99.0- Segmental and somatic dysfunction is the most likely ICD-10 replacemento Don’t code this if there is a better option (there isn’t)o Ten options

• M99.1- Subluxation complex (vertebral) is a possibility tooo But payers are not expected to like this codeo Ten options

• S13.1- Subluxation and dislocation of cervical vertebra backwards maps to 839- Closed dislocation of cervical vertebra, so it is probably a better match for that ICD-9 codeo This code has many inclusion and exclusion notes,

and a seventh character to be investigatedo Fifty-four options

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• M54.5 Low back pain is probably the best ICD-10 replacement codeo “Loin pain” or “Lumbago” would work too

• Consider these codes instead (Excludes1)o S39.012_ low back strain

• Three optionso M51.2- lumbago due to intervertebral disc displacement

• Four optionso M54.4- lumbago with sciatica

• Three options

• Or consider this one (Excludes1)o F45.41 Pyschogenic dorsalgia

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Confirm the code1. Use the three strategies to get started

1. Common codes list2. GEMs3. Alphabetic Index




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• M54.2 cervicalgia is probably the best ICD-10 replacement code

• Consider this category instead (Excludes1)o M50.- cervicalgia due to intervertebral disc

disorder• 24 code options (specify type and region)

• Or consider this one (Excludes1)o F45.41 Pyschogenic dorsalgia

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• M54.6 Pain in the thoracic spine is probably the best ICD-10 replacement code

• Consider this category instead (Excludes1)o M51.- pain in the thoracic spine due to

intervertebral disc disorder• 13 code options (specify type and regions)

• Or consider this one (Excludes1)o F45.41 Pyschogenic dorsalgia72

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• M62.830 Muscle spasm of back is probably the best ICD-10 replacement code

• Also consider these codes (GEMs)o M62.4- Contracture of muscle or tendon (sheath)

• Up to 24 optionso M62.831 Muscle spasm of calf, including “charlie horse”o M62.838 Other muscle spasm

• Or consider these codes instead (Excludes1)o R25.2 Cramp and spasmo M79.1 Myalgia, myofascial pain syndrome

• And consider adding this code (Excludes2)o M79.81 Nontraumatic hematoma of muscles72

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• M60.88 Other Myositis, other site is probably the best choiceo There are 110 or so myositis codes, and most imply some

sort of infection. None are for the spine.

• M79.1 Myalgia suggested by GEMso AKA “myofascial pain syndrome”o Consider instead (Excludes1):

• M79.7 Fibromyalgia• M60.- Myositis • F45.8 Psychogenic rheumatism• F45.41 Soft tissue pain syndrome

• M79.7 Fibromyalgia suggested by GEMso AKA “fibromyositis, myofibromyositis, or fibrositis”o Consider instead (Excludes1):

• F45.8 Psychogenic rheumatism• F45.41 Soft tissue pain syndrome

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41Tabular list - pages 223, 245, 246

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• S13.4xx_ Sprain of ligaments of cervical spine is probably the best ICD-10 replacement code (GEMs)o Sprain of “ALL, atlanto-axial joints, atlanto-occipital

joints” or “whiplash” (and several other phrases) would work too

o The seventh character can be “A”, “D”, or “S”

• S13.8xx_ Sprain of joints and ligaments of other parts of neck should be considered as well (GEMs)

• S16.1xx_ Strain of muscle, fascia and tendon at neck level should be considered in addition (Excludes2)

• Code also any associated open wound• Use an external cause code, if applicable84

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• More than 40 pages which teach• Conventions• Guidelines• Implementation steps• Documentation

strategies• Common Codes for DCs

• Specialty specific• GEMs mapping• Alpha Index• Abridged Tabular List

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icd-10 training for chiropractic

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