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Letter to the Editor-In-Chief

Here is a request I received from one of our readers. My response has remained strictly with the coding issue and I have enlisted one of the members of our Editorial Review Board for some specific answers. I intentionally did not address any other problems at this time as I did not want to miss the point of this request.

“Dear Dr. Gundersen,
I have been working on the ICD-10 conversion with great concern. I have even taken some web-seminars on how to do it but I think I am missing a lot. Would you mind using the expertise of your journal to help me solve some dilemmas?

Here is my narrative diagnostic statement: Acute traumatic lumbar intervertebral disc syndrome grade 2 with paravertebral splinting, sciatic radiculopathy and subluxations at C2-3, C5-6-7, T4-5, L4-5, S-1-2, right posterior innominate.

Here are my old codes from ICD-9:

CODES: 722.73 355.9 728.85 724.3 729.1 724.9 739.1, 739.2, 739.4, 739.3, 739.0

Here are the two codes from ICD-10 I think equate to this:

M51.17 Intervertebral disc disorder with radiculopathy M54.16 Radiculopathy lumbosacral region My questions are:

  1. Do I need to list the subluxation codes now as I did before?
  2. Do I need to also list the lumbar pain codes (lumbalgia) like I used to?
  3. Am I on the right track?

Thanks for your help.”

There are several members of our Editorial Review Board who have expertise in this area. I have asked Dr. Evan Gwilliam to provide some pointed answers to this example with the hope of being responsive to our readers and to offer another avenue for help. He has graciously obliged. Here are his comments:

1. If you needed to report the “subluxation” codes in ICD-9, you will continue to report them in ICD- 10. The most likely ones for this scenario are segmental and somatic dysfunction (but it is suggested that you document “segmental dysfunction” rather than just “subluxation” because that phrase better matches the codes we expect payers to like)

  • M99.00 head
  • M99.01 cervical
  • M99.02 thoracic
  • M99.03 lumbar
  • M99.04 sacral
  • M99.05 pelvic

But please note that your subjective and objective findings need to clearly support medical necessity for each of these regions, especially if you are billing a 98942.

2. You would list the lumbar pain codes, like you used to, but only if they are not, in your clinical opinion, routinely associated with any other diagnosis you are reporting for this encounter. For example, you would not report lumbalgia when the patient also has a lumbar strain because everyone agrees that the strain already includes low back pain. But I think it is appropriate to report it along with the disc codes.

3. To be honest, you are not on the right track. The two codes you have chosen are mutually exclusive of each other. They should not be reported together because, in the tabular list, they list each other under the “excludes1” note. And, conceptually, this makes sense. M51.17 contains the information about the disc and the radiculopathy, so there is no reason to report the M54.16.

Furthermore, your diagnostic statement does not contain enough information to support several of you ICD-9 codes, much less the extra details specified by ICD-10. Keep in mind that more codes does not mean that the case is more payable. Especially if the documentation does not support them. If you improved your diagnostic statement a little more, you could also add M62.830- muscle spasm of back. But consider documenting that phrase instead of “splinting” because your choice of words should match the codes to remove all doubt.

This answer was provided by Dr. Gwilliam of the ChiroCode Institute. Please visit ChiroCode.com for more ICD-10 and documentation help.

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The Journal of the Academy of Chiropractic Orthopedists welcomes your comments on these and any other issues you wish to provide feedback on.

Please address your comments or concerns to the Editors via our contact form

Editor-In-Chief
Bruce Gundersen, DC, FACO

Editor
Stanley N. Bacso, DC, FACO, FCCO(C)

Associate Editor
James Demetrious, DC, FACO

Associate Editor
David Swensen, DC, FACO

Associate Editor
Alicia Marie Yochum, R.N, D.C., DACBR