Yes, I know we are close to the One Year Anniversary of ICD10, but……there’s still some lingering questions.

One of them….which codes do I use to diagnose subluxations?  Is it the M991 series or the M990 series?

A recent OIG report about chiropractic says:

“Medicare requires that chiropractic claims have a primary diagnosis of “subluxation” for payment, but there is no diagnosis code that contains the word “subluxation.” CMS has instructed chiropractors to use the diagnosis codes that indicate nonallopathic lesions of the spine.”

In a typical medical dictionary, the term “subluxation” is defined as a “partial dislocation,” which is not how it is defined by many Chiropractors. The spinal codes that actually contained the word “subluxation” (839s) were consistent with the “partial dislocation” view point. Dislocations are often treated by with immobilization and/or medication by medical professionals.  In fact, it may be inappropriate to manipulate or adjust a dislocated segment. Some payers did accept the 839 codes, but, using the medical definition, a coder might argue that it does not justify chiropractic treatment. Chiropractors have been compelled to try to fit a square peg into a round hole for many years.

Along came ICD-10-CM, and it brought a few new considerations, but not necessarily a solution. The clear replacement for 739- codes are the M99.0- codes, which are “segmental and somatic dysfunction”. The word “subluxation” is still missing. However, these are the ones that Medicare contractors have instructed chiropractors to use, and private payers likely follow suit.

To summarize, use M99.0- codes whenever you used to use 739- codes, unless you get clarification from a payer. If your documentation says “subluxation”, the most correct code would be from the “S” chapter. If you say “subluxation complex”, then use the M99.1- codes. But since both of those are potentially problematic, it may be best to document something like “segmental dysfunction (subluxation)” so that the M99.0- codes are the clear choice. Throwing the word “subluxation” in there in parentheses lets Medicare know that you know that they want to see it, even though you can’t actually code for it.

To download a free copy of a Medicare Cheat Sheet, click here.