Key ICD-10 Changes for Chiropractic in 2025
Dr. Evan Gwilliam, Senior Vice President at Practisync, outlines essential updates to the ICD-10 coding system that chiropractic physicians need to know for 2025. Watch the video to learn more!
*This video follows our article “ICD 10 Changes October 1, 2024” published on 9/11/2024. You can read that article here.
Advertisement
Transcript:
Hi, I am Dr. Evan Gwilliam. I am the Senior Vice President at Practisync, which is a company that will help you bridge efficiencies and realize more success through your revenue cycle management related to your insurance collections. We have a bunch of experts on coding and compliance and documentation, and we can help you with those things. Today I want to share with you what you need to be aware of to be prepared for the changes to ICD-10 for the fiscal year 2025. They went into effect on October 1, 2024, and these changes have been available to us for several months now, and I dug through the guidelines, the agenda that you can find on Medicare’s website. But there are just a few changes that I think chiropractors need to be aware of.
The big one is a change to the codes for disc degeneration in the lumbar and lumbosacral regions. These are codes m5, 136, and m5137, that’s what the codes used to be. Now they’ve added an additional character to those codes. The additional character indicates whether or not the disc degeneration includes discogenic back pain only, lower extremity pain, or both, or there’s an option for you didn’t bother documenting so which where that extra pain is. I believe it’s very important for you to use these new codes with the sixth character because, number one, the fifth character code is no longer valid, and number two, it’s going to provide detail that will help the payer determine whether or not your care is medically necessary. So it’s very important you determine whether or not your patient has low back pain or extremity pain, in addition to this disc problem you’ve identified, and if you don’t bother specifying that in your record, then you could use the code that says I didn’t bother specifying I don’t know. But, that’s going to make you look bad and probably make it so its harder for you to get paid. So that is the biggest change to ICD 10 that chiropractors need to be aware of. So m5136, and m5137, are just a generation lumbar or lumbosacral, and there’s now a character you’re going to use zero for back pain, one for lower extremity pain, and two for both. And that’s the biggest change.
There are a few other changes I don’t think are quite as important, but you might want to be aware of, and that’s synovitis. There’s a code m65.9 for synovitis and tenosynovitis. They’ve added a fifth and sixth character to this code, and they specify the location. For example, a fifth character one is upper arm, the fifth character six is the ankle, and so on. And they’ve added the sixth character, rather one and two for right and left. So if you want to code for tenosynovitis, you should add that extra detail. If you use the old code, which has four characters, it’s going to get it’s going to get denied. It’s not a valid code. You have to have six characters now for the body site and the laterality.
One other change you might want to be aware of is socioeconomic circumstances – they’ve expanded a few codes to talk about whether or not the patient has insufficient health insurance coverage or insufficient welfare support. These kinds of codes are not typically required but could be useful in just reporting details that can help it so that you have told the whole story right on the claim form without having to share your records with someone. So those are the key changes that I’ve recognized for chiropractors, for ICD-10, for the year 2025 if you want to go and find out more, you can contact me at Practisync, or you can go right to Medicare’s website and download all the changes and take a look at them. So I hope that was helpful to you. Thanks for listening and reach out to Practisync if you would like more help with your revenue cycle management related to insurance collections, and we can help with all the coding and billing stuff. That’s us. Thanks.
