Stick to the Rules in ICD-10

Stick to the Rules in ICD-10

As the ICD-10 deadline looms closer and closer to the October 1, 2014 implementation date, it is important that every provider and his or her staff learn the rules pertaining to the ICD-10 codes.


The codes have been separated into 21 different chapters.  Each chapter has specific rules that pertain to the ICD-10 codes in that chapter.  Of the 21 chapters, the chiropractic scope of practice will involve the following chapters:


Chapter 6 – Diseases of the Nervous System (G00-G99)

Chapter 9 – Diseases of the Circulatory system (I00-I99)

Chapter 13 – Diseases of the musculoskeletal system and connective tissue (M00-M99)

Chapter 15 – Pregnancy, childbirth and the puerperium (O00-O99) 

Chapter 19 – Injury, poisoning and certain other consequences of external causes

Chapter 20 – External causes of morbidity (V00-Y99)

As an example, in chapter 13, the guidelines for musculoskeletal and connective tissue system diagnosis will involve both site and laterality.  For some conditions where more than one bone, joint or muscle is usually involved, such as osteoarthritis, there is a “multiple sites” code.  If there is not a multiple site code, then you will have to use multiple codes to indicate the multiple sites involved.  In addition, the codes are much more specific.  We use codes in the ICD-9 system that are universal.  As an example, the ICD-9 code for osteoarthritis of the knee and lower leg is 716.15.  However, in ICD-10 codes, there is a specific code for right knee osteoarthritis (M17.11) and another for osteoarthritis of the left knee (M17.12).  There is a code for osteoarthritis of the unspecified knee (M17.10), but would you really want to report to the carrier that the patient has osteoarthritis of the knee, but you don’t know what knee?  Unspecified codes should be shunned.

7th Character Requirement

In Chapter 19, the guidelines for injury, poisoning, and certain other consequences of external causes are extensive.  Most of what we treat in a typical chiropractic encounter will be contained in this chapter.  Many of the codes in chapter 19 have a 7th character requirement for each applicable code.  When required, the 7th character will denote if the treatment is for a new physician or active care (A), the healing or recovery phase (D), or a sequela (S).

When you are coding injuries, the code for the most serious injury goes first in hierarchy.  This is determined by the doctor or provider. As in ICD-9, the hierarchy and the “sequence” of the codes are important in determining if your claim will be approved or denied.

Rules and Guidelines

The changes in ICD-10 codes, the new claim form and the rules and guidelines in proper coding are more important now more than ever before in our career.  Herbert Spencer is credited with first using the phrase “survival of the fittest.”  Of course, he used the phrase in reference to Charles Darwin’s On the Origin of Species.  In the changes that are facing us as a profession, indeed natural selection will result in survival of the fittest in the evolution of chiropractic.  Proper education and detail in your office procedures will result in financial survival in your practice.

Dr. Fucinari and the ICS will be presenting several classes in the coming months to aid the doctor and staff in the transition to ICD-10.  For an updated schedule of classes and locations, go to and  Dr. Fucinari is a Certified Medical Compliance Specialist and a Certified Insurance Consultant.  Dr. Fucinari is the author of several books, including, ICD-10 Coding of the Top 100 Conditions for the Chiropractic Officeavailable at www.Askmario.comFor further information on compliance audits, books or record reviews, please contact Dr. Fucinari at

About Author

Mario P. Fucinari DC, CPCO, CPPM, CIC

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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