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ICD-10 Training For Chiropractic

In this training program, Dr. Gwilliam, a certified ICD-10 instructor, will build on the basics and dive into specialty specific guidelines for Chiropractic.

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ICD-10 Training For Chiropractic

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  1. Dr. Evan Gwilliam • Education • Bachelor’s of Science, Accounting - Brigham Young University • Master’s of Business Administration - Broadview University • Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic • Certifications • Certified Professional Coder (CPC) - AAPC • Nationally Certified Insurance Coding Specialist (NCICS) - NCCT • Certified Chiropractic Professional Coder (CCPC) - AAPC • ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode • Certified Professional Coder – Instructor (CPC-I) - AAPC • Medical Compliance Specialist – Physician (MCS-P) - MCS • Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS • Certified ICD-10 Trainer - AAPC

  2. Overview • Part 1 - ICD-10 fundamentals and navigation • Part 2 - Coding conventions and guidelines • Part 3 - ICD-10 code selection strategies • Part 4 - Documentation improvement ***Specialty specific training

  3. Top ICD-9 codes for DCs • 739.1 Segmental and somatic dysfunction, cervical • 739.3 Segmental and somatic dysfunction, lumbar • 739.2 Segmental and somatic dysfunction, thoracic • 724.2 Lumbago • 723.1 Cervicalgia • 728.85 Spasm of muscle • 724.1 Pain in the thoracic spine • 729.1 Myalgia and myositis, unspecified • 847.0 sprains and strains of neck

  4. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  5. 1. Common Codes Page 50

  6. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  7. 739- segmental and somatic dysfunction GEMs code map Page 96

  8. 739- segmental and somatic dysfunction GEMs code map

  9. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  10. 739- segmental and somatic dysfunctionAlphabetic Index Page 470

  11. 739- segmental and somatic dysfunctionAlphabetic Index Page 471

  12. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  13. 739- segmental and somatic dysfunctionTabular List Page 252

  14. 739- segmental and somatic dysfunctionTabular List Page 279

  15. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  16. 739- segmental and somatic dysfunctionTabular List Page 252

  17. 739- segmental and somatic dysfunctionTabular List Pages 278-279

  18. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  19. S13.1- Subluxation of cervical vertebra Backwards code map

  20. 739- segmental and somatic dysfunctionSummary • M99.0- Segmental and somatic dysfunction is the most likely ICD-10 replacement • Don’t code this if there is a better option (there isn’t) • Ten options • M99.1- Subluxation complex (vertebral) is a possibility too • But payers are not expected to like this code • Ten options • S13.1- Subluxation and dislocation of cervical vertebrabackwards maps to 839- Closed dislocation of cervical vertebra, so it is probably a better match for that ICD-9 code • This code has many inclusion and exclusion notes, and a seventh character to be investigated • Fifty-four options

  21. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  22. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  23. 724.2 lumbago Common codes list Common codes - Page 50

  24. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  25. 724.2 lumbago GEMs code map Code Map - Page 83

  26. 724.2 lumbago GEMs code map ChiroCode.com – members only

  27. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  28. 724.2 lumbago Alphabetic Index Index - Page 470

  29. 724.2 lumbago Alphabetic Index Index - Page 458

  30. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  31. 724.2 lumbago Tabular List Tabular – Page 222

  32. M54.5 Low back pain is probably the best ICD-10 replacement code • “Loin pain” or “Lumbago” would work too • Consider these codes instead (Excludes1) • S39.012_ low back strain • Three options • M51.2- lumbago due to intervertebral disc displacement • Four options • M54.4- lumbago with sciatica • Three options • Or consider this one (Excludes1) • F45.41 Pyschogenicdorsalgia 724.2 lumbago Summary

  33. Confirm the code • Use the three strategies to get started • Common codes list • GEMs • Alphabetic Index • Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. • Within the Tabular List, look at the following: • Notes • Includes and alternative wording • Excludes1 • Excludes2 • Code Also, Code First, Use Additional • Seventh character extensions • Reverse map for confirmation if necessary

  34. M54.2 cervicalgia is probably the best ICD-10 replacement code • Consider this category instead (Excludes1) • M50.- cervicalgia due to intervertebral disc disorder • 24 code options (specify type and region) • Or consider this one (Excludes1) • F45.41 Pyschogenicdorsalgia 723.1 cervicalgia Summary

  35. M54.6 Pain in the thoracic spine is probably the best ICD-10 replacement code • Consider this category instead (Excludes1) • M51.- pain in the thoracic spine due to intervertebral disc disorder • 13 code options (specify type and regions) • Or consider this one (Excludes1) • F45.41 Pyschogenicdorsalgia 724.1 pain in the thoracic spine Summary

  36. M62.830 Muscle spasm of back is probably the best ICD-10 replacement code • Also consider these codes (GEMs) • M62.4- Contracture of muscle or tendon (sheath) • Up to 24 options • M62.831 Muscle spasm of calf, including “charlie horse” • M62.838 Other muscle spasm • Or consider these codes instead (Excludes1) • R25.2 Cramp and spasm • M79.1 Myalgia, myofascial pain syndrome • And consider adding this code (Excludes2) • M79.81Nontraumatic hematoma of muscles 728.85 spasm of muscle Summary

  37. Code map Page 87 Tabular list Page 230

  38. M60.88 Other Myositis, other siteis probably the best choice • There are 110 or so myositis codes, and most imply some sort of infection. None are for the spine. • M79.1 Myalgia suggested by GEMs • AKA “myofascial pain syndrome” • Consider instead (Excludes1): • M79.7 Fibromyalgia • M60.- Myositis • F45.8 Psychogenic rheumatism • F45.41 Soft tissue pain syndrome • M79.7 Fibromyalgia suggested by GEMs • AKA “fibromyositis, myofibromyositis, or fibrositis” • Consider instead (Excludes1): • F45.8 Psychogenic rheumatism • F45.41 Soft tissue pain syndrome 729.1 myalgia and myositis, unspecified Summary

  39. Code map-Page 88

  40. Tabular list - pages 223, 245, 246

  41. S13.4xx_ Sprain of ligaments of cervical spine is probably the best ICD-10 replacement code (GEMs) • Sprain of “ALL, atlanto-axial joints, atlanto-occipital joints” or “whiplash” (and several other phrases) would work too • The seventh character can be “A”, “D”, or “S” • S13.8xx_ Sprain of joints and ligaments of other parts of neck should be considered as well (GEMs) • S16.1xx_ Strain of muscle, fascia and tendon at neck level should be considered in addition (Excludes2) • Code also any associated open wound • Use an external cause code, if applicable 847.0 sprains and strains of neck Summary

  42. More than 40 pages which teach • Conventions • Guidelines • Implementation steps • Documentation strategies • Common Codes for DCs • Specialty specific • GEMs mapping • Alpha Index • Abridged Tabular List • Use “EG20” to save $20 at ChiroCode.com

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