Chiropractic Coding & Compliance Alert

ICD-10/Reimbursement:

Get a Foothold With the Medicare Recommended Chiropractic Codeset

Published on Thu Nov 12, 2015

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Here’s how to know the codes Medicare wants you to use.

Are you astounded by the multiple code options in ICD-10? Even though it’s true that the 70,000 odd code set is overwhelming in itself, the fact remains that you actually should be using less than one percent of these in your practice. “Chiropractors are limited to the number of diagnoses due to the specialty,” says Doreen Boivin, CPC, CCA, with Chiro Practice, Inc., in Saco, Maine.

Most of the people go by their erstwhile ICD-9 superbills and take the help of a GEM to get an ICD-10 crosswalk. However, this may not work at all times, because the payer might not recognize the new codes yet. One way to take control of the ICD-10 codes is to collect and create a ready reference of the codes that are Medicare approved.

“I would recommend making sure the appropriate codes are chosen each time,” advises Boivin. “Don’t go looking for codes. If you are unsure, get help and code correctly the first time.”

Medicare has already published a list of ICD-10 codes for chiropractics that are federally approved for payment and other private payers are likely to follow suit. Using these lists can give you a head start, as you would know for sure your codes would not be denied, provided you use them in proper context with the diagnosis.

Even if you submit your claims to a private or commercial payer, you would still benefit from these lists because these private payers, though not bound by Medicare dictums, usually tend to formulate their payment decisions based on Medicare policies.

Word of caution: Remember, however, that a private payer is under no obligation to pay for a service rendered with an ICD-10 diagnosis on Medicare’s list if it is not on the specific payer’s list.

Know Where to Look for the Right Codes

Look for the Local Coverage Determination (LCD) policies of your Medicare carrier to stay updated on applicable codes. Although the code set will be more or less similar, there is slight variation in the LCD approved by one carrier in one region as compared to the other.

How to find it: Go to your Medicare carrier website and check information for Part B, as this covers the chiropractic services. Choose the state or jurisdiction within which your state is and go to the LCD link. This is where you will find the chiropractic reimbursement policies and a list of primary and secondary diagnosis codes in the latter half of the document.

In case if you just want to look up a code, you can type in the keyword and get the appropriate ICD-10 code using this CMS link: https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx?KeyWord=sciatica&bc=AAAAAAAAAAACAA==&.

You can also checkout the Rapidcoder chart for Chiropractic, from The Coding Institute, as a ready reference that has been carefully drafted after a thorough review of the most often required Medicare approved codes, so that you have to look no further.