ICD-10 Changes Indicates the Need for Specificity

Glasses sitting on an insurance policy

The latest changes in ICD-10 took effect last Monday, October 1, 2018.  Unlike CPT and HCPCS codes, ICD-10 codes are updated on October 1 each year.  Each year not only brings about code changes, but unfamiliarity with policy changes will leave you wondering as your reimbursements shrink.

The new 2019 ICD-10 additions have shown an increased specificity in the classifications of certain conditions, especially evident in musculoskeletal conditions. The specificity will aid in providing a better understanding of conditions affecting our patients. 


On October 1, 2018, 473 code changes occur. The total number of ICD-10 CM codes are now at 71, 932 active ICD-10 codes.  This includes 279 new codes, 143 revised codes and 51 deactivated codes.  The number of code changes is decreasing each year, but the insurance policy changes are evolving quickly.  In years past, one may have gotten away with using unspecified codes such as “cervicalgia” and “lumbalgia,” but those days are coming to an end.

The Main Concept

The main concept to grasp in the use of ICD-10 is that you should never use a diagnosis that you would not verbalize to a patient in your report of findings.  Neck pain (cervicalgia) or low back pain (lumbalgia), is not a diagnosis, but rather a symptom.  In addition, symptoms of a condition should not be reported separately.  As an example, it would not be appropriate to report lumbalgia and paresthesia with sciatica, since those symptoms are a part of the larger picture in sciatica.

The fiscal year 2019 changes have emphasized this concept even more with the deletion of Myalgia (M79.1).  Myalgia has been replaced with codes of increased specificity, as follows:  Myalgia, unspecified site (M79.10), Myalgia of mastication muscles (M79.11), Myalgia of auxiliary muscles of the head and neck (M79.12), and Myalgia of other sites (M79.18).  However, that does not mean that you would want to use any or all of these codes.  As an example, Medicare has already clarified that it will only accept the M79.12 and M79.18 codes in the chiropractic practice.

Other chapters have also seen numerous changes.  Depending on your area of practice concentration, some practices may see more changes than others.  Those who practice functional medicine may see numerous changes as of October 1.  Here is a synopsis of the changes per chapter:

The following chapters have the most changes:

• Chapter 2: Neoplasms – 45 new codes in this chapter are related to the upper/lower eyelids right or left eye
• Chapter 7: Diseases of the Eye and Adnexa – now specify upper or lower lids
• Chapter 11: Diseases of the Digestive System – 15 new codes, including those which describe generalized versus localized peritonitis
• Chapter 14: Diseases of the Genitourinary System – 17 new codes, plus two deleted codes and one revised
• Chapter 15: Pregnancy, Childbirth and the Puerperium – 18 new codes covering multiple gestations
• Chapter 16: Certain Conditions Originating in the Perinatal Period – 25 new codes dealing with newborn complications related to maternal drug use, metabolic disorders in the newborn and newborns affected by the Zika Virus – 5 deleted codes to be replaced with more specific new codes
• Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes – 54 new codes, 3 deleted and 87 revised

Every practice should review and be aware of changes that affect them.  Other revisions of the codes included spacing or spelling corrections.  

To prepare for these ICD-10 changes, it helps to have an electronic health record system that will update the codes.  If that is not an option for you, it is best to turn to classes and publications that will explain code changes, and, more importantly, policy changes affected by the code changes.  
The use of ICD-10 diagnosis codes is of vital importance in the health care of patients and for reimbursement.  The physician that does not stay up to date with these changes does a disservice to patients, and to the practice’s bottom line.

About Author

Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO

Dr. Mario Fucinari has helped train doctors and staff over the last 20 years. He received his bachelor's degree from Wayne State University in Detroit and his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1986. Dr. Fucinari was the recipient of the 1998 and the 2003 President's Award from the Illinois Chiropractic Society (ICS) for his work with education and training and most recently received the 2012 Chiropractor of the Year award from the ICS. Dr. Fucinari was the first chiropractic physician to attain the Certified Medical Compliance degree. Two years later he earned his degree as a Certified Instructor for the Certified Medical Compliance Program. He is now the Chairman of the Chiropractic division of the national medical compliance program. He has produced classes and publications on HIPAA, Clinical Documentation, Medicare, and Stroke and Cervical Manipulation. He is a worldwide speaker for NCMIC, Foot Levelers, ChiroHealthUSA and several state associations and a Certified Chiropractic Sports Physician [CCSP].Online CME CoursesConnect

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