March 25, 2014

ICD-10 FAQs for Chiropractors

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EDITOR’S NOTE: The following is Part I in a continuing series of frequently asked questions that chiropractors have concerning the implementation of ICD-10.

Do you remember those bands from the 1970s and 80s who only came up with one great hit? You know the songs word for word when you hear them now, but you can’t seem to remember the name of the band, because they never came up with anything else. These are the so-called “one-hit wonders.”

 

As the director of education for the ChiroCode Institute and the only chiropractor who is also an AAPC-certified ICD-10 instructor, I have been invited to speak in dozens of states to help train doctors of chiropractic, who, unlike many health professionals, do not have certified professional coders on staff. In other words, I have become one of those one-hit wonders. I feel like a bit of a rock star who knows that the ICD-10 song is my only hit, but heck, I may as well enjoy my short-lived fame. As I write this on an airplane, I am en route to speak in two states, one audience expected to number about 370 and the other 400. Both of these are “sold-out” events, and as such, I have been invited back to speak three more times in both states. I am pretty much booked like this every week for the next six months.

A few weeks ago, I taught a webinar on ICD-10 for chiropractors. It too was “sold out,” with a maximum of 1,001 participants. I agreed to respond to any unanswered questions that were posted to the chat during the event, but once I received the 18-page list I immediately regretted my offer. Listed below is a selection of some of the most common questions I hear at my events. I post it here in the hopes that I can just refer future audiences to this and minimize my repetition. Since there were so many questions, this piece is part one of three.

ICD-10 seems to have suddenly come to the forefront in the world of healthcare, and it is expected to remain there for the next year or so. I predict that five years from now, folks will wonder why it was such a big deal. It will be very familiar to everyone, much like those great one-hit wonder rock songs from the 1980s.

Questions Asked by Attendees

Q: Do you anticipate that the specialty ICD-10 books will need to be updated after the Medicare LCD list is made public?
A: No. The Medicare LCD is drawn from the same tabular list found in most specialty books because the codes were frozen in 2012. Products such as “commonly used codes” lists may change a little because they were created based on too many unknowns. Regardless, the tabular list in specialty books will remain unchanged and should include everything chiropractors will need.

Q: Where can you find a common code list?
A: In the ChiroCode ICD-10 book we created about 12 pages of commonly used codes, sorted by anatomical regions. These codes were selected based on commonly used ICD-9 equivalents and by just browsing the code set to look for new codes that chiropractors might use. Watch for the latest Medicare LCD with the ICD-10 codes that chiropractors will be able to submit on claims beginning Oct. 1. It is anticipated that most payors will use similar codes.

Q: Is there one source to go to look up ICD-10, or should we look it up in multiple books?
A: You can purchase the full ICD-10-CM code set from several publishers or download it for free from CDC.gov. Most chiropractors will probably only need a few hundred of the codes at most. The ChiroCode ICD-10 book contains about 12,000 of the 68,000 codes available. If you are in a multidisciplinary practice, you may want to purchase other specialty books or the complete code set. You can also search the code set and access general equivalency mappings, or GEMs (for code mapping), with the free FindACode app on a tablet or smartphone.

Q: Since there are several ways to find an ICD-10 code (i.e. using GEMs, browsing a commonly used code list, searching the alphabetic index), is there one method that has a higher priority over another to establish ICD-10 codes for efficient/proper chiropractic billing?
A: Medicare suggests that we simply read the doctor’s note and look up the code using the alphabetic index. Commonly used code lists and GEMs are simply tools to assist, and cannot be relied upon to finalize code selection. Regardless, using the tabular list is the only way to be sure that the code is correct.

Q: What is difference between ICD-10 CM and PCS?
A: ICD-10-PCS contains another 80,000 procedure codes (give or take) that are for use in a facility or hospital setting only. They will not be used in the outpatient setting, and therefore have no impact on most chiropractors.

Q: Are there any plans to change CPT codes as well?
A: No. CPT codes are unchanged by the ICD-10 transition.

Q: Are we still using E&M coding with the new codes?
A: ICD-10 is just diagnosis codes. We will still be using the same CPT codes for procedures.

Q: Could we use the old CMS-1500 forms with the new codes? How about the new forms with the old codes?
A: The old form is to be retired April 1. Since ICD-10 does not kick in until Oct. 1, 2014, there won’t be any opportunity to list them on the old form. Between April 1 and Oct. 1, we will be using ICD-9 codes on the newer CMS-1500. After that, it will be all new forms and new codes.

Q: Suppose a Medicare patient fell at home, causing neck, upper back, and lower back complaints, and he or she received chiropractic manipulative therapy code 98941 as the treatment. Are the subluxation codes still the odd-numbered codes used in box 21 on the CMS-1500 claim form? And the secondary codes go in the even-numbered spaces? Where would the V, X, and Y codes go?
A: The new claim form labels each code with the letters A-L rather than 1-4 to avoid confusion in the diagnosis point field, box 24D. We will have new codes to use, but the rules regarding primary subluxation codes and secondary neuromusculoskeletal diagnoses will not change. V, W, X, and Y codes (i.e. external cause codes from chapter 20) are not required, but we are encouraged to use them. If we do, they will go last, according to ICD-10 guidelines for that chapter.

Q: Will modifiers change?
A: Modifiers apply to procedure codes, not diagnosis codes. The CPT codes are not altered by the ICD-10 transition.

Q: Will all CPTs need pointers to ICD-10 codes?
A: Yes. All CPTs need to point to a diagnosis code to establish medical necessity. Otherwise it looks like you have no reason to provide the care. This is not new with ICD-10. All procedures without a relevant diagnosis will be denied.

Q: Are we able to switch over to ICD-10 now and get reimbursed for it now?
A: We may not use ICD-10 codes until Oct. 1, 2014. Claims with ICD-10 codes will not be accepted before that date. However, you may be able to send test claims to some payors as the date gets closer.

Q: Will we be using ICD-10 for workers’ compensation as well?
A: ICD-10 is mandated under the HIPAA law, and workers’ compensation and PI plans are not included. They are not obligated to switch, but it is expected that most will. Check with your carriers to be sure.

Q: If a patient comes in for a therapy that is not covered under auto insurance, but is covered by health insurance, would you use ICD-9 codes for the auto claim? And then once a denial is received change the codes to ICD-10 codes for the health insurance?
A: That is a possibility…and a real mess. Fortunately, rumor has it that all major auto policies have elected to use ICD-10 codes. But you will need to check with each one you do business with to be sure.

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

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.