ICD-10 Training For Chiropractic

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Dr. Evan Gwilliam

• Education
• Bachelors of Science, Accounting - Brigham Young
  University
• Masters 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

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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

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Top ICD-9 codes for DCs

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

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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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1. Common Codes
Page 50
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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739- segmental and somatic dysfunction GEMs code
map
Page 96
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739- segmental and somatic dysfunction GEMs code
map
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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739- segmental and somatic dysfunctionAlphabetic
Index
Page 470
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739- segmental and somatic dysfunctionAlphabetic
Index
Page 471
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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739- segmental and somatic dysfunctionTabular
List
Page 252
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739- segmental and somatic dysfunctionTabular
List
Page 279
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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739- segmental and somatic dysfunctionTabular
List
Page 252
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739- segmental and somatic dysfunctionTabular
List
Pages 278-279
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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S13.1- Subluxation of cervical vertebra
Backwards code map
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739- segmental and somatic dysfunctionSummary

• M99.0- Segmental and somatic dysfunction is the
  most likely ICD-10 replacement
• Dont code this if there is a better option
  (there isnt)
• Ten options
• M99.1- Subluxation complex (vertebral) is a
  possibility too
• But payers are not expected to like this code
• 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
• This code has many inclusion and exclusion notes,
  and a seventh character to be investigated
• Fifty-four options

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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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724.2 lumbago Common codes list
Common codes - Page 50
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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724.2 lumbago GEMs code map
Code Map - Page 83
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724.2 lumbago GEMs code map
ChiroCode.com members only
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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724.2 lumbago Alphabetic Index
Index - Page 470
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724.2 lumbago Alphabetic Index
Index - Page 458
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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724.2 lumbago Tabular List
Tabular Page 222
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• M54.5 Low back pain is probably the best ICD-10
  replacement code
• Loin pain or Lumbago would work too
• Consider these codes instead (Excludes1)
• S39.012_ low back strain
• Three options
• M51.2- lumbago due to intervertebral disc
  displacement
• Four options
• M54.4- lumbago with sciatica
• Three options
• Or consider this one (Excludes1)
• F45.41 Pyschogenic dorsalgia

724.2 lumbago Summary
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Confirm the code

1. Use the three strategies to get started
2. Common codes list
3. GEMs
4. Alphabetic Index
5. Within the Tabular List, identify the meaning of
   the 4th, 5th, 6th characters, if applicable.
6. Within the Tabular List, look at the following
7. Notes
8. Includes and alternative wording
9. Excludes1
10. Excludes2
11. Code Also, Code First, Use Additional
12. Seventh character extensions
13. Reverse map for confirmation if necessary

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• M54.2 cervicalgia is probably the best ICD-10
  replacement code
• Consider this category instead (Excludes1)
• M50.- cervicalgia due to intervertebral disc
  disorder
• 24 code options (specify type and region)
• Or consider this one (Excludes1)
• F45.41 Pyschogenic dorsalgia

723.1 cervicalgia Summary
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• M54.6 Pain in the thoracic spine is probably the
  best ICD-10 replacement code
• Consider this category instead (Excludes1)
• M51.- pain in the thoracic spine due to
  intervertebral disc disorder
• 13 code options (specify type and regions)
• Or consider this one (Excludes1)
• F45.41 Pyschogenic dorsalgia

724.1 pain in the thoracic spine Summary
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• M62.830 Muscle spasm of back is probably the best
  ICD-10 replacement code
• Also consider these codes (GEMs)
• M62.4- Contracture of muscle or tendon (sheath)
• Up to 24 options
• M62.831 Muscle spasm of calf, including charlie
  horse
• M62.838 Other muscle spasm
• Or consider these codes instead (Excludes1)
• R25.2 Cramp and spasm
• M79.1 Myalgia, myofascial pain syndrome
• And consider adding this code (Excludes2)
• M79.81 Nontraumatic hematoma of muscles

728.85 spasm of muscle Summary
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Code map Page 87
Tabular list Page 230
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• M60.88 Other Myositis, other site is probably the
  best choice
• 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
• AKA myofascial pain syndrome
• Consider instead (Excludes1)
• M79.7 Fibromyalgia
• M60.- Myositis
• F45.8 Psychogenic rheumatism
• F45.41 Soft tissue pain syndrome
• M79.7 Fibromyalgia suggested by GEMs
• AKA fibromyositis, myofibromyositis, or
  fibrositis
• Consider instead (Excludes1)
• F45.8 Psychogenic rheumatism
• F45.41 Soft tissue pain syndrome

729.1 myalgia and myositis, unspecified Summary
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Code map-Page 88
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Tabular list - pages 223, 245, 246
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• S13.4xx_ Sprain of ligaments of cervical spine is
  probably the best ICD-10 replacement code (GEMs)
• Sprain of ALL, atlanto-axial joints,
  atlanto-occipital joints or whiplash (and
  several other phrases) would work too
• 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

847.0 sprains and strains of neck Summary
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• 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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