ICD-10 Changes for 2020-2021-Effective October 1, 2020
As we prepare for the changing of the season, pulling out coats ahead of the cold weather, it’s also the time to pull out current coding books. Because ICD-10 diagnosis codes are controlled by the government, they work on a government fiscal year, October 1-September 30. New codes go into effect prior to CPT code changes that happen every January. For that reason, we must be diligent in reviewing our diagnosis codes and habits to prepare for the updates. This year there are several new diagnosis codes commonly used in Chiropractic and some that have been discontinued. Here we outline some of the changes that are expected to affect doctors in this profession.
Chapter 13-Diseases of the Musculoskeletal System
Usually, the most dog-eared pages in a chiropractor’s coding book are from this chapter of codes. For 2021, this chapter has 57 new codes and 3 deleted codes (M92.50, M92.51, and M92.52 Juvenile osteochondrosis). Many of these new codes simply add options for “other specified sites” providing another option for individual areas that didn’t exist before. Most of these fixed the problem of your only option being a specific site (like a certain joint) or an unspecified site. Now, these changes open the possibility for “another specified site” if not listed with a code.
The codes for TMJ have been expanded to describe other specified sites of arthritis and osteoarthritis, as well as arthritis and arthropathy of the TMJ (e.g., M266.51, Arthropathy of right temporomandibular joint). In addition, there are added bilateral and bone-specific codes for juvenile osteochondrosis of the tibia and fibula such as M92.523 (Juvenile osteochondrosis of tibia tubercle, bilateral). Be sure to have your codebook in front of you.
Avoid “Unspecified” and “Not Elsewhere Classified” if Possible
Codes with “Unspecified” or “not elsewhere classified (NEC)” notated in the title are for use when the information in the medical record provides detail for a code that does not exist in ICD-10. The provider is then left with choosing a more generalized code, or in other words, it's “as good as it gets.” Last year they chose to expand the code this way for diagnosing myalgia. If the location of the myalgia were not the head and neck but another specific region, you would most likely use code M79.18 - ‘other site.’ This means the medical record provides detail for which a specific code does not exist. Nobody wants to say the ‘medical record is insufficient’ so when possible, AVOID using “unspecified” diagnosis codes. For this, we are grateful that many of the code families have been updated to include this option.
These are a collection of some of the updated, “other specified” codes added for this year:
- M24.19 Other articular cartilage disorders, other specified site
- M24.29 Disorder of ligament, other specified site
- M24.39 Pathological dislocation of other specified joint, not elsewhere classified
- M24.49 Recurrent dislocation, other specified joint
- M24.59 Contracture, other specified joint
- M24.69 Ankylosis, other specified joint
- M24.89 Other specific joint derangement of other specified joint, not elsewhere classified
- M25.39 Other instability, other specified joint
- M25.59 Pain in other specified joint
- M25.69 Stiffness of other specified joint, not elsewhere classified
Here are the changes to the TMJ family of codes:
- M26.641 Arthritis of right temporomandibular joint
- M26.642 Arthritis of left temporomandibular joint
- M26.643 Arthritis of bilateral temporomandibular joint
- M26.649 Arthritis of unspecified temporomandibular joint
- M26.651 Arthropathy of right temporomandibular joint
- M26.652 Arthropathy of left temporomandibular joint
- M26.653 Arthropathy of bilateral temporomandibular joint
- M26.659 Arthropathy of unspecified temporomandibular joint
Changes to the Description of Headache
In ICD-10, headache related conditions reside in Chapter 6, Diseases of the Nervous System, and most begin with the letter G. An example is G44.201, described as Tension-type headache, unspecified, intractable. Don’t worry…these haven’t changed. But a review of this code in your coding resource indicates an “Excludes 1” remark for Headache code R51. A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1. So, we are taught not to use R51 at the same time as a G level headache code.
Now enter the updated ICD-10 code set. R51 has been deleted as of October 1, 2020. There are two more specific codes to replace it.
- R51.0 Headache with orthostatic component, not elsewhere classified
- R51.9 Headache, unspecified
ICD-10 Additional Changes
There are almost 600 changes that include 490 new codes and 47 revised codes in the update this year. We have only elaborated on the ones that are most likely to affect chiropractors. In total, there are now 72,606 codes for you to choose from. Please review all your codes on an annual basis and ensure they are up to date to avoid claim denials after October 1. Don’t forget to update these in your practice management software for all billing October 1 or later.
Remember to read the Instructions. Each year the Coding Guidelines are updated. Be sure you understand the terms such as ‘and’, ‘code also’ and the recently updated term ‘with’ (see Page 12 of 120) of the ICD-10 CM Official Guidelines for Coding and Reporting.
Because making the right coding choices saves time and money, learn to get your chiropractic coding done right, the first time. Understand exactly what is necessary to protect your practice, and maximize your profitability – quickly, and easily.
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Rebecca Scott is a Certified Professional Coder who began her chiropractic career in 1989. She graduated in 2008 with an Associate’s Degree in Accounting and is a Licensed Clinical Chiropractic Assistant in the state of Maine. She’s a member of the Lewiston Chapter of the American Association of Professional Coders (AAPC) and is both a certified specialist working in curriculum development and an individual client consultant for KMC University. She or any of her teammates can be reached at email@example.com or by calling 855-832-6562.