It’s easy to forget the power of the diagnostic code in the healthcare world in relation to ICD 10 coding for chiropractic, especially when it comes to reimbursement
A virus outbreak that began in China over three months ago has now infected more than 164,000 people in the United States, according to the World Health Organization (WHO). The WHO declared the virus a pandemic during a press conference in Geneva.
Many states and communities here at home have made on-site placement mandatory. And hidden somewhere deep in every DC, doctor’s office, hospital, nursing home, and Walmart pharmacy, a staff member is busy trying to find the most appropriate diagnostic code for the latest national headline. Wait what
ICD 10 coding for chiropractic
The key link between the coding task and the headings resides in the data source. One hundred and sixty-four thousand people infected because of data. Clinically the data is scientifically sound, but if the Center for Disease Control (CDC), WHO or a primary insurance company is unwilling to go through every single medical record and laboratory result, the data source is a three to seven digit code. ICD 10 coding for chiropractic care – more specifically, an ICD-10 CM code.
In other words, the headline actually says that 164,000 people were treated in a medical facility and received the diagnostic code associated with COVID-19. Is it possible that someone has been treated and diagnosed but “coded” as an unspecified virus or flu?
It’s easy to forget the power of the diagnostic code in the healthcare world and ICD 10 coding for chiropractic. Does it really matter whether the patient’s neck pain is assigned the code M54.2 (cervicalgia) or the more unambiguous diagnosis S13.4XXA (sprain of the ligaments of the cervical spine) or even a more specific seventh character S13.4XX?S. to indicate that the pain is a result of a previous sprain? Does it make sense to include V89.2XXS in order to link this encounter with the motor vehicle accident (MVA) last summer?
I assume a follow-up visit to the office and an x-ray are paid for using one of these valid codes. But when that one claim is added to the insurance database they share with the Atlanta CDC, which is shared with the WHO and statistics are used for persuasion, or when you seek reimbursement from a indemnity payer, the devil is in the details.
In the United States, health policy and reimbursement are framed around the term “medical necessity”. Benefits are reimbursed if they are found to meet, but not exceed, the patient’s clinical needs. The patient with neck pain due to poor posture at the computer and the patient with cervical cancer due to a previous MVA with whiplash are not the same. The course of treatment and the resources needed for the best result may not be the same. Use caution in presenting these two patients as the same by using the same diagnostic codes for the claims.
Defending the medical necessity of the services provided in a clinical setting depends on the accuracy of the translation of a clinical impression into a universal code set. The most direct way to reduce the number of CO50 rejections is to improve the diagnostic codes that are submitted. A general code for neck pain may not communicate the need for months of recurring pain management appointments as clearly as the additional detail in G89.21 (Chronic trauma pain).
However, this translation task often falls on a computerized list of favorite codes. Make sure to use all the features of your EHR to efficiently and accurately find the codes defining your patient’s full medical history. Just because the unspecified virus code is the easiest to find doesn’t mean it is the best choice.
Karna Morrow, CPC, RCC, CCS-P, is the implementation manager for Practice EHR. She has spent nearly three decades in the industry leading electronic health record (EHR) implementation, providing advice and training to a variety of healthcare organizations. Morrow is a frequent contributor to highly regarded industry publications and national conferences, providing insights into practice management, coding, billing, and other industry-related topics.