How to determine what diagnosis codes to select from the ICD-10 options?
One of the purposes of converting to the ICD-10 diagnosis code set was to increase the specificity of diagnosis codes used to describe a patient’s condition and also to add codes where ICD-9 codes weren’t available for conditions (like for IT band syndrome). As a result, providers are now expected to use the most descriptive ICD-10 code available to diagnose patient conditions. The ICD-10 database includes many “unspecified” or “nonspecific” codes and the GEMS mapping system shows a crossover from ICD-9 codes to many of those non-specific codes. For example, Sciatica 724.3 ICD-9 code maps to ICD-10 code M54.30 for Sciatica, unspecified side even though ICD-10’s most descriptive codes for sciatica include the side (right side vs. left side) and also includes options that include the involvement of lumbago.
To best utilize the new ICD-10 code set, start with selecting diagnosis codes from Clinic Doctor’s EHr Fee Slip - opt for codes that best fit the patient’s condition. For a condition that that patient has on both sides (bilaterally) but a bilateral code doesn’t exist, select both the right and left options. The diagnosis code look-up function can search for both ICD-10, ICD-9, and a description if you need to look for alternative codes not listed in our fee slip.
Another option for making your most-often utilized ICD-10 codes readily available in the most specific forms is to build your clinic’s Frequent Problems List. To access this area in your system, go to Administrative Tools > Frequent Problems List and from here you can add ICD-10 codes of your choosing from the ICD-10 database to your own Frequent Problems List. The Frequent Problems List populates whenever a manual search for a diagnosis code occurs - from the Add Other Dx area of the fee slip and also within the Patient Problem List.
For established patients in Clinic Doctor, review claims for 10/1/15 going forward in the Pending Claims folder. There may be diagnosis codes selected based on prior ICD-9 usage that are not to the highest level of specificity. Edit the procedure to view the ICD-10 codes selected to determine if any non-specific codes are pointed to the procedure. From here you can select a code from their problems list that better fits the condition being treated or you can link to their problems list to add additional codes as needed.
The Medicare LCD is a great reference to use when selecting diagnosis codes, especially when selecting/ordering diagnoses for a Medicare patient.
Here are links of Medicare LCDs for Chiropractic by state:
Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin:
Effective date 10-1-2015
Subluxation Codes
| M99.00 | Segmental somatic dysfunction head region (occipital) |
| M99.01 | Segmental somatic dysfunction cervical region |
| M99.02 | Segmental somatic dysfunction thoracic region |
| M99.03 | Segmental and somatic dysfunction, lumbar region |
| M99.04 | Segmental and somatic dysfunction, sacral, sacrococcygeal, sacroiliac regions |
| M99.05 | Segmental and somatic dysfunction, hip, pelvis, pubic region |
| Al8.01 | Tuberculosis of spine |
| G44.89 | Other headache syndrome |
| G54.2 | Cervical root disorders, not elsewhere classified |
| G54.3 | Thoracic root disorders, not elsewhere classified |
| G54.4 | Lumbosacral root disorders, not elsewhere classified |
| G54.8 | Other nerve root and plexus disorders |
| GSS | Nerve root and plexus compressions in diseases classified elsewhere |
| G57.21 | Lesion of femoral nerve, right lower limb |
| G57.22 | Lesion of femoral nerve, left lower limb |
| M40.12 | Other secondary kyphosis, cervical region |
| M40.13 | Other secondary kyphosis, cervicothoracic region |
| M40.14 | Other secondary kyphosis, thoracic region |
| M40.15 | Other secondary kyphosis, thoracolumbar region |
| M40.292 | Other kyphosis, cervical region |
| M40.293 | Other kyphosis, cervicothoracic region |
| M40.294 | Other kyphosis, thoracic region |
| M40.295 | Other kyphosis, thoracolumbar region |
| M40.35 | Flatback syndrome, thoracolumbar region |
| M40.36 | Flatback syndrome, lumbar region |
| M40.37 | Flatback syndrome, lumbosacral region |
| M40.45 | Postural lordosis, thoracolumbar region |
| M40.46 | Postural lordosis, lumbar region |
| M40.47 | Postural lordosis, lumbosacral region |
| M40.S0 | Lordosis, unspecified, site unspecified |
| M41.112 | Juvenile idiopathic scoliosis, cervical region |
| M41.113 | Juvenile idiopathic scoliosis, cervicothoracic region |
| M41.114 | Juvenile idiopathic scoliosis, thoracic region |
| M41.115 | Juvenile idiopathic scoliosis, thoracolumbar region |
| M41.116 | Juvenile idiopathic scoliosis, lumbar region |
| M41.117 | Juvenile idiopathic scoliosis, lumbosacral region |
| M41.122 | Adolescent idiopathic scoliosis, cervical region |
| M41.123 | Adolescent idiopathic scoliosis, cervicothoracic region |
| M41.124 | Adolescent idiopathic scoliosis, thoracic region |
| M41.125 | Adolescent idiopathic scoliosis, thoracolumbar region |
| M41.126 | Adolescent idiopathic scoliosis, lumbar region |
| M41.127 | Adolescent idiopathic scoliosis, lumbosacral region |
| M41.22 | Other idiopathic scoliosis, cervical region |
| M41.23 | Other idiopathic scoliosis, cervicothoracic region |
| M41.24 | Other idiopathic scoliosis, thoracic region |
| M41.25 | Other idiopathic scoliosis, thoracolumbar region |
| M41.26 | Other idiopathic scoliosis, lumbar region |
| M41.27 | Other idiopathic scoliosis, lumbosacral region |
| M41.34 | Thoracogenic scoliosis, thoracic region |
| M41.35 | Thoracogenic scoliosis, thoracolumbar region |
| M41.41 | Neuromuscular scoliosis, occipito-atlanto-axial region |
| M41.42 | Neuromuscular scoliosis, cervical region |
| M41.43 | Neuromuscular scoliosis, cervicothoracic region |
| M41.44 | Neuromuscular scoliosis, thoracic region |
| M41.45 | Neuromuscular scoliosis, thoracolumbar region |
| M41.46 | Neuromuscular scoliosis, lumbar region |
| M41.47 | Neuromuscular scoliosis, lumbosacral region |
| M41.52 | Other secondary scoliosis, cervical region |
| M41.53 | Other secondary scoliosis, cervicothoracic region |
| M41.54 | Other secondary scoliosis, thoracic region |
| M41.55 | Other secondary scoliosis, thoracolumbar region |
| M41.56 | Other secondary scoliosis, lumbar region |
| M41.57 | Other secondary scoliosis, lumbosacral region |
| M43.01 | Spondylolysis, occipito-atlanto-axial region |
| M43.02 | Spondylolysis, cervical region |
| M43.03 | Spondylolysis, cervicothoracic region |
| M43.04 | Spondylolysis, thoracic region |
| M43.05 | Spondylolysis, thoracolumbar region |
| M43.06 | Spondylolysis, lumbar region |
| M43.07 | Spondylolysis, lumbosacral region |
| M43.08 | Spondylolysis, sacral and sacrococcygeal region |
| M43.09 | Spondylolysis, multiple sites in spine |
| M43.11 | Spondylolisthesis, occipito-atlanto-axial region |
| M43.12 | Spondylolisthesis, cervical region |
| M43.13 | Spondylolisthesis, cervicothoracic region |
| M43.14 | Spondylolisthesis, thoracic region |
| M43.15 | Spondylolisthesis, thoracolumbar region |
| M43.16 | Spondylolisthesis, lumbar region |
| M43.17 | Spondylolisthesis, lumbosacral region |
| M43.18 | Spondylolisthesis, sacral and sacrococcygeal region |
| M43.19 | Spondylolisthesis, multiple sites in spine |
| M43.27 | Fusion of spine, lumbosacral region |
| M43.28 | Fusion of spine, sacral and sacrococcygeal region |
| M43.6 | Torticollis |
| M43.8X9 | Other specified deforming dorsopathies, site unspecified |
| M46.01 | Spinal enthesopathy, occipito-atlanto-axial region |
| M46.02 | Spinal enthesopathy, cervical region |
| M46.03 | Spinal enthesopathy, cervicothoracic region |
| M46.04 | Spinal enthesopathy, thoracic region |
| M46.05 | Spinal enthesopathy, thoracolumbar region |
| M46.06 | Spinal enthesopathy, lumbar region |
| M46.07 | Spinal enthesopathy, lumbosacral region |
| M46.08 | Spinal enthesopathy, sacral and sacrococcygeal region |
| M46.09 | Spinal enthesopathy, multiple sites in spine |
| M46.41 | Discitis, unspecified, occipito-atlanto-axial region |
| M46.42 | Discitis, unspecified, cervical region |
| M46.43 | Discitis, unspecified, cervicothoracic region |
| M46.44 | Discitis, unspecified, thoracic region |
| M46.45 | Discitis, unspecified, thoracolumbar region |
| M46.46 | Discitis, unspecified, lumbar region |
| M46.47 | Discitis, unspecified, lumbosacral region |
| M47.21 | Other spondylosis with radiculopathy, occipito-atlanto-axial region |
| M47.22 | Other spondylosis with radiculopathy, cervical region |
| M47.23 | Other spondylosis with radiculopathy, cervicothoracic region |
| M47.24 | Other spondylosis with radiculopathy, thoracic region |
| M47.25 | Other spondylosis with radiculopathy, thoracolumbar region |
| M47.26 | Other spondylosis with radiculopathy, lumbar region |
| M47.27 | Other spondylosis with radiculopathy, lumbosacral region |
| M47.28 | Other spondylosis with radiculopathy, sacral and sacrococcygeal region |
| M47.811 | Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region |
| M47.812 | Spondylosis without myelopathy or radiculopathy, cervical region |
| M47.813 | Spondylosis without myelopathy or radiculopathy, cervicothoracic region |
| M47.814 | Spondylosis without myelopathy or radiculopathy, thoracic region |
| M47.815 | Spondylosis without myelopathy or radiculopathy, thoracolumbar region |
| M47.816 | Spondylosis without myelopathy or radiculopathy, lumbar region |
| M47.817 | Spondylosis without myelopathy or radiculopathy, lumbosacral region |
| M47.818 | Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region |
| M47.891 | Other spondylosis, occipito-atlanto-axial region |
| M47.892 | Other spondylosis, cervical region |
| M47.893 | Other spondylosis, cervicothoracic region |
| M47.894 | Other spondylosis, thoracic region |
| M47.895 | Other spondylosis, thoracolumbar region |
| M47.896 | Other spondylosis, lumbar region |
| M47.897 | Other spondylosis, lumbosacral region |
| M47.898 | Other spondylosis, sacral and sacrococcygeal region |
| M48.01 | Spinal stenosis, occipito-atlanto-axial region |
| M48.02 | Spinal stenosis, cervical region |
| M48.03 | Spinal stenosis, cervicothoracic region |
| M48.04 | Spinal stenosis, thoracic region |
| M48.05 | Spinal stenosis, thoracolumbar region |
| M48.06 | Spinal stenosis, lumbar region |
| M48.07 | Spinal stenosis, lumbosacral region |
| M48.11 | Ankylosing hyperostosis [Forestier], occipito-atlanto-axial region |
| M48.12 | Ankylosing hyperostosis [Forestier], cervical region |
| M48.13 | Ankylosing hyperostosis [Forestier], cervicothoracic region |
| M48.14 | Ankylosing hyperostosis [Forestier], thoracic region |
| M48.15 | Ankylosing hyperostosis [Forestier], thoracolumbar region |
| M48.16 | Ankylosing hyperostosis [Forestier], lumbar region |
| M48.17 | Ankylosing hyperostosis [Forestier], lumbosacral region |
| M48.18 | Ankylosing hyperostosis [Forestier], sacral and sacrococcygeal region |
| M48.19 | Ankylosing hyperostosis [Forestier], multiple sites in spine |
| MS0.11 | Cervical disc disorder with radiculopathy, occipito-atlanto-axial region |
| MS0.12 | Cervical disc disorder with radiculopathy, mid-cervical region |
| MS0.13 | Cervical disc disorder with radiculopathy, cervicothoracic region |
| MS0.21 | Other cervical disc displacement, occipito-atlanto-axial region |
| MS0.22 | Other cervical disc displacement, mid-cervical region |
| MS0.23 | Other cervical disc displacement, cervicothoracic region |
| MS0.31 | Other cervical disc degeneration, occipito-atlanto-axial region |
| MS0.32 | Other cervical disc degeneration, mid-cervical region |
| MS0.33 | Other cervical disc degeneration, cervicothoracic region |
| MS0.81 | Other cervical disc disorders, occipito-atlanto-axial region |
| MS0.82 | Other cervical disc disorders, mid-cervical region |
| MS0.83 | Other cervical disc disorders, cervicothoracic region |
| MS0.91 | Cervical disc disorder, unspecified, occipito-atlanto-axial region |
| MS0.92 | Cervical disc disorder, unspecified, mid-cervical region |
| MS0.93 | Cervical disc disorder, unspecified, cervicothoracic region |
| MSl.14 | lntervertebral disc disorders with radiculopathy, thoracic region |
| MSl.15 | lntervertebral disc disorders with radiculopathy, thoracolumbar region |
| MSl.16 | lntervertebral disc disorders with radiculopathy, lumbar region |
| MSl.17 | lntervertebral disc disorders with radiculopathy, lumbosacral region |
| MSl.24 | Other intervertebral disc displacement, thoracic region |
| MSl.25 | Other intervertebral disc displacement, thoracolumbar region |
| MSl.26 | Other intervertebral disc displacement, lumbar region |
| MSl.27 | Other intervertebral disc displacement, lumbosacral region |
| MSl.34 | Other intervertebral disc degeneration, thoracic region |
| MSl.35 | Other intervertebral disc degeneration, thoracolumbar region |
| MSl.36 | Other intervertebral disc degeneration, lumbar region |
| MSl.37 | Other intervertebral disc degeneration, lumbosacral region |
| MSl.84 | Other intervertebral disc disorders, thoracic region |
| MSl.85 | Other intervertebral disc disorders, thoracolumbar region |
| MSl.86 | Other intervertebral disc disorders, lumbar region |
| MSl.87 | Other intervertebral disc disorders, lumbosacral region |
| M53.2X7 | Spinal instabilities, lumbosacral region |
| M53.2X8 | Spinal instabilities, sacral and sacrococcygeal region |
| M53.3 | Sacrococcygeal disorders, not elsewhere classified |
| M53.81 | Other specified dorsopathies, occipito-atlanto-axial region |
| M53.82 | Other specified dorsopathies, cervical region |
| M53.83 | Other specified dorsopathies, cervicothoracic region |
| M53.87 | Other specified dorsopathies, lumbosacral region |
| M53.88 | Other specified dorsopathies, sacral and sacrococcygeal region |
| M54.03 | Panniculitis affecting regions of neck and back, cervicothoracic region |
| M54.04 | Panniculitis affecting regions of neck and back, thoracic region |
| M54.05 | Panniculitis affecting regions of neck and back, thoracolumbar region |
| M54.06 | Panniculitis affecting regions of neck and back, lumbar region |
| M54.07 | Panniculitis affecting regions of neck and back, lumbosacral region |
| M54.08 | Panniculitis affecting regions of neck and back, sacral and sacrococcygeal region |
| M54.09 | Panniculitis affecting regions, neck and back, multiple sites in spine |
| M54.11 | Radiculopathy, occipito-atlanto-axial region |
| M54.12 | Radiculopathy, cervical region |
| M54.13 | Radiculopathy, cervicothoracic region |
| M54.14 | Radiculopathy, thoracic region |
| M54.15 | Radiculopathy, thoracolumbar region |
| M54.16 | Radiculopathy, lumbar region |
| M54.17 | Radiculopathy, lumbosacral region |
| M54.2 | Cervicalgia |
| M54.31 | Sciatica, right side |
| M54.32 | Sciatica, left side |
| M54.41 | Lumbago with sciatica, right side |
| M54.42 | Lumbago with sciatica, left side |
| M54.5 | Low back pain |
| M54.6 | Pain in thoracic spine |
| M54.81 | Occipital neuralgia |
| M54.89 | Other dorsalgia |
| M54.9 | Dorsalgia, unspecified |
| M62.830 | Muscle spasm of back |
| M96.1 | Postlaminectomy syndrome, not elsewhere classified |
| M96.3 | Postlaminectomy kyphosis |
| M96.4 | Postsurgical lordosis |
| M99.20 | Subluxation stenosis of neural canal of head region |
| M99.21 | Subluxation stenosis of neural canal of cervical region |
| M99.22 | Subluxation stenosis of neural canal of thoracic region |
| M99.23 | Subluxation stenosis of neural canal of lumbar region |
| M99.30 | Osseous stenosis of neural canal of head region |
| M99.31 | Osseous stenosis of neural canal of cervical region |
| M99.32 | Osseous stenosis of neural canal of thoracic region |
| M99.33 | Osseous stenosis of neural canal of lumbar region |
| M99.40 | Connective tissue stenosis of neural canal of head region |
| M99.41 | Connective tissue stenosis of neural canal of cervical region |
| M99.42 | Connective tissue stenosis of neural canal of thoracic region |
| M99.43 | Connective tissue stenosis of neural canal of lumbar region |
| M99.50 | lntervertebral disc stenosis of neural canal of head region |
| M99.51 | lntervertebral disc stenosis of neural canal of cervical region |
| M99.52 | lntervertebral disc stenosis of neural canal of thoracic region |
| M99.53 | lntervertebral disc stenosis of neural canal of lumbar region |
| M99.60 | Osseous and subluxation stenosis of intervertebral foramina of head region |
| M99.61 | Osseous and subluxation stenosis of intervertebral foramina of cervical region |
| M99.62 | Osseous and subluxation stenosis of intervertebral foramina of thoracic region |
| M99.63 | Osseous and subluxation stenosis of intervertebral foramina of lumbar region |
| M99.70 | Connective tissue and disc stenosis of intervertebral foramina of head region |
| M99.71 | Connective tissue and disc stenosis of intervertebral foramina of cervical region |
| M99.72 | Connective tissue and disc stenosis of intervertebral foramina of thoracic region |
| M99.73 | Connective tissue and disc stenosis of intervertebral foramina of lumbar region |
| M99.83 | Other bio-mechanical lesions of lumbar region |
| M99.84 | Other bio-mechanical lesions of sacral region |
| Q67.5 | Congenital deformity of spine |
| Q76.2 | Congenital spondylolisthesis |
| Q76.3 | Congenital scoliosis due to congenital bony malformation |
| Q76.425 | Congenital lordosis, thoracolumbar region |
| Q76.426 | Congenital lordosis, lumbar region |
| Q76.427 | Congenital lordosis, lumbosacral region |
| Q76.428 | Congenital lordosis, sacral and sacrococcygeal region |
| Q76.49 | Other congenital malformations of spine, not associated with scoliosis |
| S13.4XXA | Sprain of ligaments of cervical spine, initial encounter |
| S13.8XXA | Sprain of joints and ligaments of other parts of neck, initial encounter |
| S14.2XXA | Injury of nerve root of cervical spine, initial encounter |
| S14.2XXS | Injury of nerve root of cervical spine, sequela |
| S14.3XXS | Injury of brachiaI plexus, sequela |
| S14.4XXS | Injury of peripheral nerves of neck, sequela |
| S14.SXXS | Injury of cervical sympathetic nerves, sequela |
| S14.8XXS | Injury of other specified nerves of neck, sequela |
| S16.1XXA | Strain of muscle, fascia and tendon at neck level, initial encounter |
| S23.3XXA | Sprain of ligaments of thoracic spine, initial encounter |
| S23.8XXA | Sprain of other specified parts of thorax, initial encounter |
| S24.2XXA | Injury of nerve root of thoracic spine, initial encounter |
| S24.2XXS | Injury of nerve root of thoracic spine, sequela |
| S24.3XXS | Injury of peripheral nerves of thorax, sequela |
| S24.4XXS | Injury of thoracic sympathetic nervous system, sequela |
| S24.8XXS | Injury of other specified nerves of thorax, sequela |
| S33.SXXA | Sprain of ligaments of lumbar spine, initial encounter |
| S33.6XXA | Sprain of sacroiliac joint, initial encounter |
| S33.8XXA | Sprain of other parts of lumbar spine and pelvis, initial encounter |
| S34.21XS | Injury of nerve root of lumbar spine, sequela |
| S34.22XA | Injury of nerve root of sacral spine, initial encounter |
| S34.22XS | Injury of nerve root of sacral spine, sequela |
| S34.3XXS | Injury of cauda equina, sequela |
| S34.4XXS | Injury of lumbosacral plexus, sequela |
| S34.SXXS | Injury of lumbar, sacral and pelvic sympathetic nerves, sequela |
| S34.6XXS | Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, sequela |
| S34.8XXS | Injury of other nerves at abdomen, lower back and pelvis level, sequela |