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1
Dr. Evan Gwilliam
• Education
• Bachelor’s of Science, Accounting - Brigham Young University
• Master’s of Business Admini...
Overview
• Part 1 - ICD-10 fundamentals and navigation
• Part 2 - Coding conventions and guidelines
• Part 3 - ICD-10 code...
1. 739.1 Segmental and somatic dysfunction, cervical
2. 739.3 Segmental and somatic dysfunction, lumbar
3. 739.2 Segmental...
Confirm the code
5
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within t...
1. Common Codes
6
Page
50
Confirm the code
7
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within t...
8
739-segmentaland
somaticdysfunction
GEMscodemap
Page
96
9
739-segmentaland
somaticdysfunction
GEMscodemap
Confirm the code
10
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
739-segmentaland
somaticdysfunction
AlphabeticIndex
11
Page
470
739-segmentaland
somaticdysfunction
AlphabeticIndex
12
Page
471
Confirm the code
13
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
14
739-segmentaland
somaticdysfunction
TabularList
Page
252
15
739-segmentaland
somaticdysfunction
TabularList
Page
279
Confirm the code
16
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
17
739-segmentaland
somaticdysfunction
TabularList
Page
252
18
739-segmentaland
somaticdysfunction
TabularList
Pages
278-279
Confirm the code
19
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
20
S13.1-Subluxationof
cervicalvertebra
Backwardscodemap
• M99.0- Segmental and somatic dysfunction is
the most likely ICD-10 replacement
o Don’t code this if there is a better op...
Confirm the code
22
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
Confirm the code
23
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
24
724.2lumbago
Commoncodeslist
Common codes - Page 50
Confirm the code
25
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
26
724.2lumbago
GEMscodemap
Code Map - Page 83
27
724.2lumbago
GEMscodemap
ChiroCode.com – members only
Confirm the code
28
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
29
724.2lumbago
AlphabeticIndex
Index - Page 470
30
724.2lumbago
AlphabeticIndex
Index - Page 458
Confirm the code
31
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
32
724.2lumbago
TabularList
Tabular – Page 222
• M54.5 Low back pain is probably the best
ICD-10 replacement code
o “Loin pain” or “Lumbago” would work too
• Consider th...
Confirm the code
34
1. Use the three strategies to get started
1. Common codes list
2. GEMs
3. Alphabetic Index
2. Within ...
• M54.2 cervicalgia is probably the best
ICD-10 replacement code
• Consider this category instead
(Excludes1)
o M50.- cerv...
• M54.6 Pain in the thoracic spine is
probably the best ICD-10
replacement code
• Consider this category instead
(Excludes...
• M62.830 Muscle spasm of back is probably
the best ICD-10 replacement code
• Also consider these codes (GEMs)
o M62.4- Co...
38
Code
map
Page 87
Tabular
list
Page 230
• M60.88 Other Myositis, other site is
probably the best choice
o There are 110 or so myositis codes, and most imply some
...
40
Code map-
Page 88
41
Tabular list - pages 223,
245, 246
• S13.4xx_ Sprain of ligaments of cervical spine
is probably the best ICD-10 replacement
code (GEMs)
o Sprain of “ALL, atl...
43
44
• More than 40 pages which teach
• Conventions
• Guidelines
• Implementation steps
• Documentation strategies
• Common Cod...
46
47
48
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ICD-10 Training for Chiropractic

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Certified Professional Coder (CPC) - AAPC
Nationally Certified Insurance Coding Specialist (NCICS) - NCCT
Certified Chiropractic Professional Coder (CCPC) - AAPC
ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode
Certified Professional Coder – Instructor (CPC-I) - AAPC
Medical Compliance Specialist – Physician (MCS-P) - MCS
Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS
Certified ICD-10 Trainer - AAPC

Published in: Healthcare
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ICD-10 Training for Chiropractic

  1. 1. 1
  2. 2. Dr. Evan Gwilliam • Education • Bachelor’s of Science, Accounting - Brigham Young University • Master’s of Business Administration - Broadview University • Doctor of Chiropractic, Valedictorian - Palmer College of Chiropractic • Certifications • Certified Professional Coder (CPC) - AAPC • Nationally Certified Insurance Coding Specialist (NCICS) - NCCT • Certified Chiropractic Professional Coder (CCPC) - AAPC • ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode • Certified Professional Coder – Instructor (CPC-I) - AAPC • Medical Compliance Specialist – Physician (MCS-P) - MCS • Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS • Certified ICD-10 Trainer - AAPC 2
  3. 3. Overview • Part 1 - ICD-10 fundamentals and navigation • Part 2 - Coding conventions and guidelines • Part 3 - ICD-10 code selection strategies • Part 4 - Documentation improvement ***Specialty specific training 3
  4. 4. 1. 739.1 Segmental and somatic dysfunction, cervical 2. 739.3 Segmental and somatic dysfunction, lumbar 3. 739.2 Segmental and somatic dysfunction, thoracic 4. 724.2 Lumbago 5. 723.1 Cervicalgia 6. 728.85 Spasm of muscle 7. 724.1 Pain in the thoracic spine 8. 729.1 Myalgia and myositis, unspecified 9. 847.0 sprains and strains of neck 4 Top ICD-9 codes for DCs
  5. 5. Confirm the code 5 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  6. 6. 1. Common Codes 6 Page 50
  7. 7. Confirm the code 7 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  8. 8. 8 739-segmentaland somaticdysfunction GEMscodemap Page 96
  9. 9. 9 739-segmentaland somaticdysfunction GEMscodemap
  10. 10. Confirm the code 10 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  11. 11. 739-segmentaland somaticdysfunction AlphabeticIndex 11 Page 470
  12. 12. 739-segmentaland somaticdysfunction AlphabeticIndex 12 Page 471
  13. 13. Confirm the code 13 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  14. 14. 14 739-segmentaland somaticdysfunction TabularList Page 252
  15. 15. 15 739-segmentaland somaticdysfunction TabularList Page 279
  16. 16. Confirm the code 16 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  17. 17. 17 739-segmentaland somaticdysfunction TabularList Page 252
  18. 18. 18 739-segmentaland somaticdysfunction TabularList Pages 278-279
  19. 19. Confirm the code 19 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  20. 20. 20 S13.1-Subluxationof cervicalvertebra Backwardscodemap
  21. 21. • M99.0- Segmental and somatic dysfunction is the most likely ICD-10 replacement o Don’t code this if there is a better option (there isn’t) o Ten options • M99.1- Subluxation complex (vertebral) is a possibility too o But payers are not expected to like this code o Ten options • S13.1- Subluxation and dislocation of cervical vertebra backwards maps to 839- Closed dislocation of cervical vertebra, so it is probably a better match for that ICD-9 code o This code has many inclusion and exclusion notes, and a seventh character to be investigated o Fifty-four options 21 739-segmentaland somaticdysfunction Summary
  22. 22. Confirm the code 22 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  23. 23. Confirm the code 23 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  24. 24. 24 724.2lumbago Commoncodeslist Common codes - Page 50
  25. 25. Confirm the code 25 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  26. 26. 26 724.2lumbago GEMscodemap Code Map - Page 83
  27. 27. 27 724.2lumbago GEMscodemap ChiroCode.com – members only
  28. 28. Confirm the code 28 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  29. 29. 29 724.2lumbago AlphabeticIndex Index - Page 470
  30. 30. 30 724.2lumbago AlphabeticIndex Index - Page 458
  31. 31. Confirm the code 31 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  32. 32. 32 724.2lumbago TabularList Tabular – Page 222
  33. 33. • M54.5 Low back pain is probably the best ICD-10 replacement code o “Loin pain” or “Lumbago” would work too • Consider these codes instead (Excludes1) o S39.012_ low back strain • Three options o M51.2- lumbago due to intervertebral disc displacement • Four options o M54.4- lumbago with sciatica • Three options • Or consider this one (Excludes1) o F45.41 Pyschogenic dorsalgia 33 724.2lumbago Summary
  34. 34. Confirm the code 34 1. Use the three strategies to get started 1. Common codes list 2. GEMs 3. Alphabetic Index 2. Within the Tabular List, identify the meaning of the 4th, 5th, 6th characters, if applicable. 3. Within the Tabular List, look at the following: 1. Notes 2. Includes and alternative wording 3. Excludes1 4. Excludes2 5. Code Also, Code First, Use Additional 6. Seventh character extensions 4. Reverse map for confirmation if necessary
  35. 35. • M54.2 cervicalgia is probably the best ICD-10 replacement code • Consider this category instead (Excludes1) o M50.- cervicalgia due to intervertebral disc disorder • 24 code options (specify type and region) • Or consider this one (Excludes1) o F45.41 Pyschogenic dorsalgia 35 723.1cervicalgia Summary
  36. 36. • M54.6 Pain in the thoracic spine is probably the best ICD-10 replacement code • Consider this category instead (Excludes1) o M51.- pain in the thoracic spine due to intervertebral disc disorder • 13 code options (specify type and regions) • Or consider this one (Excludes1) o F45.41 Pyschogenic dorsalgia 36 724.1paininthe thoracicspine Summary
  37. 37. • M62.830 Muscle spasm of back is probably the best ICD-10 replacement code • Also consider these codes (GEMs) o M62.4- Contracture of muscle or tendon (sheath) • Up to 24 options o M62.831 Muscle spasm of calf, including “charlie horse” o M62.838 Other muscle spasm • Or consider these codes instead (Excludes1) o R25.2 Cramp and spasm o M79.1 Myalgia, myofascial pain syndrome • And consider adding this code (Excludes2) o M79.81 Nontraumatic hematoma of muscles 37 728.85spasmofmuscle Summary
  38. 38. 38 Code map Page 87 Tabular list Page 230
  39. 39. • M60.88 Other Myositis, other site is probably the best choice o There are 110 or so myositis codes, and most imply some sort of infection. None are for the spine. • M79.1 Myalgia suggested by GEMs o AKA “myofascial pain syndrome” o Consider instead (Excludes1): • M79.7 Fibromyalgia • M60.- Myositis • F45.8 Psychogenic rheumatism • F45.41 Soft tissue pain syndrome • M79.7 Fibromyalgia suggested by GEMs o AKA “fibromyositis, myofibromyositis, or fibrositis” o Consider instead (Excludes1): • F45.8 Psychogenic rheumatism • F45.41 Soft tissue pain syndrome 39 729.1myalgiaand myositis,unspecified Summary
  40. 40. 40 Code map- Page 88
  41. 41. 41 Tabular list - pages 223, 245, 246
  42. 42. • S13.4xx_ Sprain of ligaments of cervical spine is probably the best ICD-10 replacement code (GEMs) o Sprain of “ALL, atlanto-axial joints, atlanto-occipital joints” or “whiplash” (and several other phrases) would work too o The seventh character can be “A”, “D”, or “S” • S13.8xx_ Sprain of joints and ligaments of other parts of neck should be considered as well (GEMs) • S16.1xx_ Strain of muscle, fascia and tendon at neck level should be considered in addition (Excludes2) • Code also any associated open wound • Use an external cause code, if applicable 42 847.0sprainsandstrainsof neck Summary
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  44. 44. 44
  45. 45. • More than 40 pages which teach • Conventions • Guidelines • Implementation steps • Documentation strategies • Common Codes for DCs • Specialty specific • GEMs mapping • Alpha Index • Abridged Tabular List Use “EG20” to save $20 at ChiroCode.com
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