Today, Dr. Evan Gwilliam (SVP of Practisync – www.practisync.com) joins Marc Abla, CAE to discuss the upcoming changes to ICD10 codes that may impact chiropractic physicians in Illinois.
Transcript:
Marc:
Every year, the ICD-10 codes update on October one. This year, we’re actually having Dr. Evan Guilliam, who is the senior vice president with Practisync. That if you need some help with your billing, reach out to Dr. Evan, and he can walk you through the process of looking at a billing company, but that’s not why we’re here today. Really, what we’re here today is to talk about the ICD-10 changes that are coming up that may impact your office. So, Dr. Gwilliam, go ahead and talk to us a little bit about the changes that may impact us.
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Dr. Gwilliam:
So every year they release these preliminary changes to us. You can get them; you can Google it and find it on the Medicare website. They are very easy to find. And this year the changes are not that big a deal, but still noteworthy. I check these every year, and we try to get them out there. And so let’s just take a minute and make sure you guys know which codes changed or were added, or what is different that you should be aware of as chiropractic physicians, as providers who need to understand the musculoskeletal system in particular.
So there’s really two that I identified. I took that file of changes from Medicare. I just scan it. That’s what I do every year. Just look through. It was about, I think it was 35 or 40 pages this year. I found two big changes, or not even that big, significant changes for chiropractors. The first one is for feet. So, if any of you do any treatment for feet, you need to know that the code for plantar fasciitis got a little better. Plantar fasciitis has gotten a little better. It used to be lumped in with the M72 codes, which is where you find plantar fascial fibromatosis, and it was an inclusion term, and they were just there. What they did was they separated them out. M72.2 got to keep plantar fascial fibromatosis, got to keep that one, but we added right and left, and then plantar fasciitis got their own codes, and they are M67.A, and there’s a right and left with that. The right foot ends with the character one, and the left foot is the character two. That’s pretty consistent throughout all of ICD-10, by the way. And so that’s that’s one significant change. You can better describe these two different foot conditions. They have their own codes. They’re not lumped together anymore. There’s a right and a left, and that’s it.
Marc:
So, what are just so everybody knows? Go ahead and tell us what are the new plantar fasciitis codes and how? What were the exact impacts of changing for what that you know what that M72 code used to be to what it is now?
Dr. Gwilliam:
Well, so you had M72.2, and they expanded it and added M72.2 01 and two, which is unspecified foot, right foot, and left foot. By the way, I strongly discourage you from coding for unspecified foot. That sort of implies you didn’t bother documenting which foot the patient has a problem with, so don’t use that. Use the right or left. Use good clinical skills and ask a patient that question. And now you’re able to discern the difference between that and plantar fasciitis. And it also has a right, left, an unspecified foot. It’s M67, A 01, A 02, and A 09; the nine is the unspecified one. So stay away from that because again, you should know. And now you have that better clarity and laterality, which are nice to be able to communicate on a claim form. Quick side note: that does not apply until October 1. So for dates of service prior to October first, don’t employ this change, but after October 1, it’s real, it’s live, so it only applies after October 1 for dates of service. Okay.
Marc:
Now, was there also a change regarding the difficulty walking and unsteadiness? Of course, so this is the other change. Yes, right. So, what is that change?
Dr. Gwilliam:
Thank you for leading me into that. No, there is one other change that I think is significant for chiropractors, and there was a code for R2681, which is unsteadiness on your feet, and the other one that’s significant here is R26.2, which is difficulty in walking. What they did was those two codes had an excludes one relative to each other. Now, this is a very important ICD-10 rule. It’s probably the most important one if you don’t know any of them because it affects your payment. If you use codes that have an excludes one, they can deny the claim and say used invalid codes. Excludes one means they’re mutually exclusive; they can’t be done together. And they used to feel like these two things-difficulty in walking and unsteadiness on your feet-were mutually exclusive. You couldn’t report them together, and if you did, it would be an error. But they decided that they can be reported together. They changed it to an excludes two. Excludes two in ICD-10 rules means that these two things do not include each other, and if the patient has both of them, they need to both be reported.
So that’s what’s changed. Now you can report both of these codes if both of those findings are present for your patient. But let me go on a little tangent on this one. The R codes come from the chapter; I think it’s chapter 16 in ICD 10, and they are signs and symptoms. And the guidelines let us know that you can report these types of codes. But if you have a more definitive diagnosis, you should go there first. So they’re useful codes to tell about a patient’s symptoms for chiropractors. But if they have a condition with their feet, like I don’t know, plantar fibromyosis, for example, you could report those more specific codes, and they do a better job of defining a condition. The symptom codes are useful, but not nearly as useful as an actual condition because they’re just a symptom. Does that make sense?
Marc:
Yeah. So let me ask you this question, and just from from the outside looking in, then is it possible for let’s combine these two changes into a conversation, right? So let’s say someone has plantar fasciitis of the right foot, so they’re gonna they’re gonna drop an M67.A01, and that one is indicating the right foot, right? And as a result of that, that ultimately they’re having some difficulty walking, and they have some unsteadiness. So in theory, is it possible to bill the M67.A01 to be very clear what the condition is and what’s creating the problem, and then also add now the R26.2 and the R 26.81, and so it’s all on the claim form, telling a full story about that patient.
Dr. Gwilliam:
Now the advantage there is you don’t have to send them your notes to tell the story; they can just see the claim form and figure it out. I would just, and this is me speculating from a clinical perspective. I feel like unsteadiness on feet is not necessarily related to a foot condition. That’s more of a balance issue to me. Maybe related to, you know, even diabetic neuropathy or traumatic brain injury or something. So I think that’s one of the reasons they separated. They said, you know, this is someone got difficulty in walking because of a foot problem, but unsteadiness on feet because of a neurological problem, for example, and that’s why they are now more clearly separately reportable or reportable together because they don’t report the same thing. And originally, they kind of felt like they did. I guess somebody made this decision, and I think this one makes sense. It’s a good one.
Marc:
Yeah, I I would agree, and I want to just take a second here, and also just kind of really emphasize one of the things that we’ve talked about, and because you mentioned, hey, these you know they’re in the R code, they’re explanatory, you know, they’re explanatory, and maybe they’re kind of a secondary thought to everybody. One of the things that is super important for us as a profession, and for you as an individual doctor, in order to get paid better moving forward, is your first communication with the insurance company about what you did in your practice. It’s not your documentation. Your documentation is critical, but that communication is the claim form. If you communicate better on your claim form of exactly what you did in the practice and exactly what’s wrong with the patient. What we see-it’s not perfect-but what we see is a reduced number of denials that happen, and so it’s super important that we tell a good story on the claim form.
We want to avoid the insurance company asking you for records. We want to avoid the insurance company downcoding. We want to avoid the insurance company denying the claim outright and having you know making you have to go through the process of appeal or trying to collect from your patient or whatever the case is. If we tell better stories on the claim form, we find that reimbursement is better for our doctors. It’s worth taking the extra time. And you may say, well, not today, really; I’m not having a problem, Marc. I’m not just concerned about today. Although I’m concerned about today, I’m concerned about tomorrow, next week, next year, as they implement more and more policies and more and more claims edits, and quite candidly, more AI that can do faster rejections. We want your claim form to be as rock solid as possible. And if you start good habits today, then we’re being proactive and not reactive later. What do you think? I mean, is that about? Yeah,
Dr. Gwilliam:
Yeah, I think of the claim form as like the level one communication. Get as much as you can over to them on that first level of communication because if they have to ask for level two, which is your documentation, that’s more work for everybody. You got to pull it together. You got to get it to them. They have to review it, just more time delays in payment, more things for them to look for to find problems with, and it definitely is a trait of an effective practice that gets paid well, that they have great codes chosen and outlined on their claim form to tell as much of the stories they can on that first line of communication. I wholeheartedly agree. Good point.
Marc:
I would almost liken it to this, and I’m not sure if this is a perfect analogy, but I’m going to use it anyway for fun. It’s like when a patient comes in, and they fill out, you know, first-time patient, they fill out your intake forms, and they indicate that they’re having low back pain, and you ask them about everything that they’re having, you know, and their entire suite of issues that and challenges that they have, and now you’re going through your examination, you’re. Through this, and all of a sudden, in the middle of the conversation, they mention that they’re having this incredible right foot pain, and all of a sudden, now you realize, wait a minute, that is that is pertinent information. It would have been good to know up front, right? And so this is almost like an akin to this process. If they would have filled out their paperwork, it potentially could have reduced the amount of time that you spent on that examination with them, or improved your examination and your findings more quickly, or even better. Right at the end of the day, and it’s even worse if the patient, you know, never really tells you up front at all, right, that they have this foot pain, and you just find out later on, you know, the outcomes are always better for that patient if you know the entire story and you can diagnose better up front. We believe the same thing is true with your claim form. If they know the whole story up front, your likelihood of getting paid and your outcomes are going to be better if you tell that story better up front.
Dr. Gwilliam:
Yeah, we’re storytellers, you know, as clinicians, and we need to tell a good, solid story. And these code changes, well, they seem like they might be a little tedious to keep track of. In many cases, they allow us to tell a better story, which translates to patients getting better outcomes and doctors getting paid properly for what they do. So, use these changes. Do a better job with your claim forms, and think of it as the way that you can get that message out there, and you’ll have a more successful practice. We hope.
Marc:
That’s it. Well, thank you so much for joining us this week. We’ll catch you next.
