Chiropractors Transitioning from ICD-9 to ICD-10

August 17, 2015
Chiropractic Medicare 2015ICD-10 Change and Easy Transition

     As we approach the ICD-10 deadline, let us do a little preparation so the transition from ICD-9 to ICD-10 is easy. First question..... How many of you wish to become Coding Experts? I suspect NONE want to become Coding Experts.... so you will enjoy this article and it may even take a little pressure off.

     Secondly, to really take a little pressure off, CMS (Centers for Medicare & Medicaid Services Office of the Administrator) presented a letter to all Medicare Providers dated July 7, 2015 that contains a paragraph as follows:

    “For 12 months after ICD-10 implementation, Medicare review contractors will NOT deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family.  However, a valid ICD-10 code will be required on all codes starting October 1, 2015” 

     That clearly means that after October 2015 NO ICD-9 codes may be used on any claim, not only to Medicare, but all insurances.  The transition must be 100%.  Prior to October 1, 2015, NO ICD-10 code are acceptable.  Wednesday evening, September 30 will be the end of ICD-9 codes forever.

     To prevent delays in payment, it is important to bill all your Medicare and insurance claims as quickly as possible prior to October 1, 2015.  So Thursday morning, October 1, 2015, all your patient diagnosis must be changed as you see the patient and do their S.O.A.P. notes.  If you bill each day electronically, make sure no ICD-9 codes appear on any claims.

     All certified software have special migration programs making it much easier to switch to ICD-10.  ChiroTouch, as an example, uses ICD-10 wizard in the diagnosis window to practice matching your present diagnosis with the new ICD-10 diagnosis.  Even though you are adding new ICD-10 diagnosis prior to October 1, no permanent changes go into the official records or any claim prior to October 1, as it is designed for practice only.

 As Chiropractors, remember, we are not reimbursed in Medicare to “treat” patient symptoms, but to locate and correct vertebral subluxations.  Your diagnosis should be a Chiropractic diagnosis with subluxations, degenerative joint disease, sprain/strain, neuritis, etc.  Practice makes perfect.....and we will soon get used to it. 

ICD-10 Migration and Episode Care

Chiropractic Medicare 2015

1.  ICD-10 Migration

2. Episode Care

1.  ICD-10 Migration

     On October 1, 2015 the ICD-9 Code sets used to report medical diagnosis and inpatient procedures will be replaced by ICD-10 code sets.  Those using certified software should be compatible with both ICD-9 and ICD-10. Your software company will provide tools to change over to ICD-10 and have the training for the provider to properly code.  If you have questions about your software being able to "Migrate to ICD-10" please call your software company TODAY.

     If you are not paperless, you may wish to print out the ICD-10 codes for your review.  It will print over 60 pages.  As you review, you will soon see very few of the ICD-10 codes will be used in your practice. Review the list and mark your codes.

     The problem for our profession is real. Somewhere around eleven thousand of the 60 thousand practicing Chiropractors became paperless and Medicare compliant.  For those not using certified software, be prepared for major delays in reimbursement by Medicare and insurance companies.  I strongly recommend having ALL your billing up-to-date prior to October 15th of this year.

2.  “Episode”

     Medicare carriers are now reviewing Chiropractic care by “Episode” units.  I have no problem with that. Our job in Medicare is NOT treating patient symptoms, but correcting vertebral subluxations.  As long as you practice like a Chiropractor in Medicare.....the fewer problems you will have. YOUR SUCCESS AND SECURITY IS UP TO YOU!    

     Be a Doctor of Chiropractic........Remember, always tell the truth!   

Maintenance Care? ~Sept 19th

"Maintenance Care" in my Chiropractic office is when a patient enters my office, they are checked, have NO subluxations and they go home.  The Medicare Program has twisted Chiropractic minds so Chiropractors forget that we have but one job in Medicare; find, prove and correct vertebral subluxations (vertebral displacements). That is all that is reimbursed to Chiropractors in the Medicare Program.

Patient symptoms are used by Chiropractors to help locate the subluxations and/or malfunctions of organs.  Just because the patient has NO symptoms does not mean the patient has NO subluxation and is now "maintenance care".  The patient has either a new condition, exacerbation, accident, neuronal component or chronic state.
To meet Medicare coverage criteria, a chiropractic office visit adjustment should be aimed at correcting subluxations related to acute injuries/reinjures or exacerbations.  The result of the Chiropractic adjustment is expected to be an achievable improvement and with a clearly defined point.  Once the maximum benefit has been achieved for a given condition, on-going maintenance therapy is not considered medically necessary under the Medicare Program.

Maintenance therapy is defined by Medicare as a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition.  Medicare does not cover maintenance therapy.
The recommendation here is: be a Chiropractor and prove the subluxation.  Document by "Federal Standards".  Listen well to the patient and correct vertebral displacements (subluxations).  Medicare has excellent Chiropractic coverage as long as we practice like Chiropractors.  If you are correcting vertebral subluxations for your Medicare patient and calling that adjustment "maintenance care" because you do not know how to document, then you have just performed a covered service in Medicare, did not "document the Chiropractic necessity of care", and cheated your patient from Medicare reimbursement. 

Remember....correcting the vertebral subluxation is the only covered service in Medicare.....and the only service we Chiropractors are mandated to bill to the Medicare Carrier. Performing a covered service and not billing that service, because of lack of knowledge or thinking it does not have to be documented or billed, is unfair to the consumer, your patient and to Chiropractic in general. As a Medicare provider, you signed a contract with our government so you have the privelige to see Medicare patients.... and that YOU will know and follow the Medicare guidelines.

Chiropractic Medicare Diagnosis (newsletter from 4/11/11)

April 11, 2011

Chiropractic Medicare Diagnosis

There are two factors involving the diagnosis of great importance. The diagnosis must be an honest diagnosis and that diagnosis must support the care rendered.

The first part of our Chiropractic diagnosis will always be a vertebral subluxation. It is our privilege and responsibility to determine the primary subluxation. Item 21, section #1 on the CMS-1500 form, will begin with the primary subluxation, either 739.1, 739.2, 739.3, 739.4 or 739.5.

After determining the primary subluxation, now you must determine the second part of the primary diagnosis. Since we are speaking about seniors over the age of 65, after doing x-rays (x-rays are mandatory each 12 months if the Chiropractor "proves" the subluxation by x-ray) the second diagnosis, since the subluxation has been present for the past 30 years, is degenerative joint disease. (You can see this condition on x-rays less than 12 months old.) This diagnosis goes in Item 21 section #2.

The third part of the diagnosis is usually why the patient came to your office. An exacerbation is any event, great or small, that has insulted pre-disposed soft tissue creating pain that the patient can place and exact time and date. Soft tissue in a predisposed degenerative joint has been insulted, stretched, torn, twisted and may be bleeding called sprain/strain.  That is the third part of the diagnosis entered into item 21 section #3.

The fourth part of item 21 will probably be your next important subluxation.

NOTE:  Each time there is a new exacerbation, date of current, item #14 is updated to date of exacerbation.