New Diagnostic Codes for the New Year

Q: I was told that there are several new diagnosis codes for 2007, and that they should be helpful for an acupuncturist when billing insurance. Do you know what they are and why those diagnosis codes are useful for an acupuncturist?

A: Each year the International Classification of Disease (ICD) codes are revised and updated. These, of course, are the codes used to describe illness, injury and disease treated by all health care providers. As most acupuncturists are aware, many insurance carriers will only pay for services by an acupuncturist when the diagnosis is pain or similar symptom (code). As a consequence, acupuncturists can often feel limited in their ability to diagnose as they note the limitation of these codes. This notion is, in reality, not completely accurate, as there are more than 130 diagnosis codes that are specific to pain and can be related to all regions of the body. It is fair to say that if you can name a region of the body, there is a code for pain that correlates with that region.

To answer your question more directly, there are some exciting additions to the diagnosis codes for 2007. Specifically, there are 11 new codes for pain (acute pain, central pain syndrome, chronic pain and generalized pain). Based on insurers limiting reimbursement for acupuncture care to pain, this adds a new dimension to the coding for traumatic and nontraumatic pain, both acute and chronic. See the chart within this article for highlights of the changes for 2007 that should be of interest to the field of acupuncture.

Of special note is the ability to diagnose pain in trauma-related conditions, both in the acute and chronic phases. The neoplasm-related pain code is also notable, as many acupuncturists treat nausea and pain associated with cancer care. This code will help to describe the complete picture of those patients.

While these codes technically took effect starting Oct. 1, 2006, it is not unusual for insurance carriers to not recognize the new codes immediately, as they may not have updated their data systems. (I find it interesting that an insurance carrier can seemingly make changes immediately when it is in its favor, but somehow lag when the opposite is the case.)

If you need an update to your coding book (I recommend you update regularly), the ICD-9 code book can be purchased from most medical book resellers. A complete diagnosis coding book is an essential tool for any health care provider. Without the complete text, the ability to describe a condition to its highest level of specificity will limit the amount of care and maximum reimbursement.