Updated on: March 14, 2016

How Do I Know Which ICD-10 Codes Payers Will LIke?

Original story posted on: December 13, 2013

One of the biggest questions doctors have these days is “which codes will I actually use when ICD-10 kicks in on Oct. 1, 2014?” This is the great mystery.

Fortunately, we have access to the same code set that payers will be using as they determine which codes they would like to see. We may not know exactly which codes are going to work, but we can and should get familiar with the options now so we are comfortable with whatever the payors select.


We turn to Medicare for guidance on this because we know that many payers also look to Medicare as an example to follow. Each Medicare Administrative Contractor (MAC) releases a “local coverage determination” (or LCD) for each specialty. Your MAC will have an LCD available for chiropractic physicians in your area. The easiest way to find yours is to use the Medicare Coverage Database, which can be found online at http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx#HowToUseThisSite (simply select your state and type in “chiropractic”). 

The LCD for Utah (where ChiroCode is based) is only 11 pages long. It might be wise for every office to take a little time to read it over. It lists, among other things, acceptable ICD-9 codes for Medicare claims.

LCDs likely are going to be the first place to look for acceptable ICD-10 codes. There were rumors that the LCD with ICD-10 codes would be available in October 2013, but October has come and gone. According to MLN Matters Document No. MM8348 (see http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8348.pdf), all LCDs with ICD-10 codes must be available in the Medicare Coverage Database by April 10, 2014.

Payers have indicated that they will not be able to accept ICD-10 codes prior to Oct. 1, 2014, but test claims will create an opportunity to see how everybody will handle these new codes. One Blue Cross Blue Shield plan sent out a letter to providers many months ago indicating that it will be able to accept test claims in early 2014. Medicare recently announced that it will have a testing period open from March 3 to March 7, 2014 (see http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8465.pdf). Watch for more information about how you might be able to participate. In the meantime, get started now and you will be a lot less stressed when the deadline hits.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

Evan M. Gwilliam, DC, MBA, BS, CPC, CCPC, CCCPC, NCICS, CPC-I MCS-P, CPMA, executive vice president of ChiroCode and Find-A-Code LLC, graduated from Palmer College of Chiropractic as valedictorian and is a certified professional coding instructor, medical compliance specialist, and professional medical auditor, among other things. He provides expert witness reports, medical record audits, consulting, and online courses for healthcare providers. He also writes books and articles for trade journals and is a sought-after seminar speaker. He has a bachelor’s degree in accounting and a master’s of business administration, and he is one of the few clinicians who is a certified ICD-10 Instructor and certified MACRA/MIPS healthcare professional.