ICD-10 Guidelines for DCs
SOURCE: ACA News ~ April 2014
By Evan M. Gwilliam, DC
The ICD-10 codes that will soon be used on CMS-1500 claim forms have many pages of guidelines that explain the rules and conventions necessary to apply them correctly. Depending on the publisher, they take up about 30 pages in the ICD-10-CM code set. Some explain items like the definition of “Excludes2” and the meaning of the semicolon or slanted brackets (see Sections 1.A and 1.B). The bulk of these guidelines, around 20 pages, are found in Section 1.C and are chapter specific. The ICD-10-CM code set is divided into 21 chapters, each one for a distinct body system or condition.
Chiropractic physicians typically use codes from just four or five of the 21 chapters available in ICD-10-CM. These include, but are not necessarily limited to, the codes from Chapter 6, diseases of the nervous system; Chapter 13, diseases of the musculoskeletal system and connective tissue; Chapter 18, symptoms, signs and abnormal clinical findings, not elsewhere classified; Chapter 19, injury, poisoning and certain other consequences of external causes. Most doctors of chiropractic (DCs) do not employ certified coders to research all of the coding changes that are specific to their specialty. They are compelled to learn coding while running a small business and continuing to focus on the clinical needs of their patients. A thorough understanding of all the guidelines in ICD-10-CM is wise, but listed below are a handful of guidelines that should be the focus.
Chapter 6 Guidelines
Chapter 6 (diseases of the nervous system) includes codes from G00 to G99, covering the nervous system. DCs frequently treat many conditions of the nervous system, but only a few guidelines are important in the typical chiropractic setting. Some chiropractic patients may suffer from hemiplegia (G81) or monoplegia (G83). The guidelines tell us that the dominant or nondominant side can be affected and should be identified. However, if dominance is not specified, code selection follows these rules:
- For ambidextrous patients, the default should be dominant;
- If the left side is affected, the default is non-dominant; and
- If the right side is affected, the default is dominant.
The general code set guidelines tell us to report only codes for conditions that are being treated or that directly affect the treatment. If a patient presents with hemiplegia (G81) that does not affect the treatment in any way, it will not be reported.