navigating ICD codes

In the world of healthcare, the International Classification of Diseases, 10th Edition (ICD-10) codes play a crucial role in ensuring accurate billing, patient care, and statistical analysis. These codes are continually updated to reflect the evolving landscape of healthcare practices, technologies, and treatments. Every October 1, significant changes to ICD-10 codes take place, and they will have a notable impact on various specialties, although this year, we don’t have many changes that affect us in the chiropractic profession. However, there are some changes that affect the prescription of orthotic inserts. In this blog post, we will delve into the key changes to ICD-10 codes effective October 1, 2023, and explore how these changes may relate to the prescription of orthotic shoe inserts.

Understanding ICD-10 Codes

Before delving into the minor changes, it’s essential to have a basic understanding of ICD-10 codes. The ICD-10 system is used globally to classify diseases, conditions, and medical procedures. These alphanumeric codes help healthcare providers:

  1. Accurately diagnose and document a patient’s condition
  2. Facilitate efficient communication between healthcare professionals
  3. Streamline the billing and insurance claims process
  4. Contribute to epidemiological research and healthcare policy decisions
  5. Classify external causes

Relevant Changes to ICD-10 Codes

The Centers for Medicare & Medicaid Services (CMS) regularly updates the ICD-10 code set to keep it current with advances in medicine and changes in clinical practice. These updates help ensure that healthcare providers can accurately report and document diagnoses and treatments. The changes effective October 1, 2023, introduce several notable modifications, including:

  1. New Codes: The introduction of new codes enables healthcare providers to specify diagnoses with greater precision. For functional orthotic prescriptions, this can be particularly beneficial when addressing specific foot conditions or types of orthotics.
  2. Revised Codes: Existing codes may be updated to better reflect the current medical understanding of certain conditions. In the context of functional orthotics, this might involve changes in how foot conditions are classified or coded.
  3. Deleted Codes: Some codes may be deleted if they are no longer relevant oconsolidated into more comprehensive codes. This could affect how certain conditions or treatments are documented.

Not Many Changes This Year

Fortunately, there are not a tremendous number of changes that affect doctors of chiropractic this year. We’ve scoured the full list of changes, and these may be of note. In this profession, we look to the “G” section for neurological issues, including headaches. These are changes to the migraine codes that may be in your system:

G43.E Chronic migraine with aura

Excludes: migraine with aura (G43.1-)

G43.E0 Chronic migraine with aura, not intractable

  • Chronic migraine with aura, without refractory migraine

G43.E01 Chronic migraine with aura, not intractable, with status migrainosus

G43.E09 Chronic migraine with aura, not intractable, without status migrainosus

  • Chronic migraine with aura NOS

G43.E1 Chronic migraine with aura, intractable

  • Chronic migraine with aura, with refractory migraine

G43.E11 Chronic migraine with aura, intractable, with status migrainosus

G43.E19 Chronic migraine with aura, intractable, without status migrainosus

There is a new code included this year in our musculoskeletal section, but no other changes are significant.

M41.12     Adolescent idiopathic scoliosis

Be sure that you have updated your computer’s diagnosis list if these are codes your practice uses.

Diagnosis Coding for Functional Orthotics

Just because a patient presents with certain conditions for which functional orthotics may be appropriate, it doesn’t mean that the payer will consider that condition for reimbursement. For example, we know that spinal instability and especially pelvic unleveling conditions are usually helped by functional orthotics. After all, the foot is the foundation of the spine … when the foot hits the ground, everything changes. But payers may have specific rules within their Medical Review Policy (MRP) that indicate which diagnoses are valid for orthotics prescriptions. A review of this document is critical to verify which ICD-10 diagnosis codes are considered medically necessary. Couple that review with a proper verification of benefits to ensure coverage. Of course, patients will pay for functional orthotics out of pocket, when appropriate, so don’t rely solely on third-party coverage when prescribing.

As part of the Orthotics from Prescription to Payment online course, there is a compilation of ICD-10 codes that have been thought medically necessary by certain payers and may be considered. It should not be considered an all-inclusive list, nor should it be relied upon as proof of coverage for any specific patient. This course is complimentary, courtesy of Foot Levelers and KMC University and the billing and coding information, including the downloadable ICD-10 list, can be found in this module:  https://learn.kmcuniversity.com/courses/orthotics-from-perscription-to-payment/lessons/billing-and-coding-guidance-for-functional-orthotics/

Stay Up to Date

One of the compliance obligations of healthcare businesses is to remain steadfast in staying up to date on changes within the industry and on top of coding changes annually. The ICD-10 code changes are always effective October 1 and CPT® coding changes are effective each January 1. Place a reminder in your annual calendar to ensure that you check in with your consultants or with CMS to update your diagnosis codes each year. This ensures that your claims will be quickly approved and you can count on smooth sailing, and feelings of certainty with your billing and coding.

See Kathy explain the four points to consider when utilizing insurance to pay for functional orthotics:

Kathy (KMC) Weidner
MCS-P, CPCO, CCPC, CCCA | Website

Kathy, better known professionally as Kathy Mills Chang, is a globally recognized expert on the compliance and financial operations of a successful chiropractic practice. With 40 years of service to the chiropractic community, she got her start as a CA in 1983. Since then, Kathy has been sharing her expertise on Medicare, compliance, billing, coding, insurance, patient financial procedures and documentation with audiences around the world. A popular and highly experienced speaker, she has served on many national and state level chiropractic organizations, boards and advisory councils. She is also the owner and CEO of KMC University, which she founded in 2007.