Physical therapy, orthopedics, and chiropractic clinics have many patients complaining of back discomfort. This condition is the most common cause of disability for U.S. adults of all ages. Yet, even the most experienced medical coding service providers acknowledge they have to report back pain using ICD-10-CM is difficult since various codes describe pain in this vast region within the human body.
According to ICD-10 M54, the section covers dorsalgia as a condition characterized by a distinct discomfort in the back region or chronic or acute pain in the posterior region in the thorax, the lumbosacral region, or in the region adjacent. Therefore, it is not a billable specific ICD-10-CM diagnosis code. Instead, it is a subcategory that describes the diagnosis more in-depth.
What Causes Back Pain?
The most frequent sign of back pain is a pain in the back. It may radiate out to the buttocks, legs or. The pain associated with an injury to the back may affect other parts of the body. The signs of back pain may differ from one individual. Some sufferers experience persistent pain, while others experience only minor discomforts and aches. Following a physical exam and questions about indicators, an accurate diagnosis and treatment can be determined.
General ICD-10 Information
ICD (International Statistics Classification for Health Conditions and Related issues) is currently in the 10th edition. ICD-10 codes have been created as an outcome of this revision. The medical classification list is created through WHO. World Health Organization (WHO) and utilized to assist healthcare professionals in determining and classifying health conditions.
ICD-10 is required by healthcare professionals and physicians in the Health Insurance Portability & Accountability Act (HIPAA) and will replace all ICD-9 codes.
A lot more diagnoses can be identified using ICD-10 than ICD-9. This is because specific expanded codes such as ICD-10-CM have more than 100,000 codes.
Code ICD-10 M54.5 is causing the”kibosh.
Each year CMS releases updates for the ICD-10 manual, eliminating redundant codes, introducing new codes, and revising the terminology as needed. This month, CMS published its latest cycle of ICD-10 modifications, including removing ICD-10 code M54.5 Low back pain, which will take effect on 1 October 2021.
This means that providers can’t use M54.5 to define the diagnosis until October 1, and existing patients who have an M54.5 diagnosis will have to be changed to an appropriate ICD-10 code. This is among the most commonly used codes in the rehabilitation therapy industry. Therefore, our compliance experts predict that this change could significantly impact the coding practices that many (if not all) rehabilitation therapists.
Some payees jumped the gun.
As the implementation of the update was near the date for rollout, some payers and Medicare Administrative Contractors began requiring the new codes before the actual switchover. As a result, some companies have seen claims denied because of errors.
Bell states that Bell has two options to do things right.
“If the claim was rejected based on updates that were not yet in place providers may appeal,” she said. “Another option is to submit the claim again with the latest codes.”
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