Question: I was made aware that the diagnosis code for back pain (M54.5) was deleted and three new codes replaced it. What do these new codes represent and how do I assure that I am using the code best equipped for an acupuncture provider? Also, are there any other codes that changed?
As occurs every Oct. 1, there are updates to the ICD 10 coding system. Some years, this update makes no difference to the common codes billed by acupuncture providers, but most years there are at least a few changes that do – and this year, like last year, does so, particularly the code for which most insurances, including Medicare, will reimburse acupuncture services.
For example, last year, there were updates to the code for headache (R51), which was revised to two new codes (R51.0 orthostatic headache and R51.9 unspecified headache). This update was essentially the only change to commonly used codes by an acupuncture provider.
New Codes for Back Pain
This year, as you referenced, the code for back pain was updated. M54.5 was deleted and replaced with three new codes:
From a billing / coding perspective, back pain generically has these approximate synonyms, which can encompass a broad spectrum of the symptomatology of back pain:
What does each of these new codes reference? M54.50, in simplest terms, means there is back pain, but no specific causation or reason is identified. This code is the most likely used for an acupuncture provider, as it is not attempting to define based on a Western nomenclature; and avoids an issue of using a differential or Western diagnosis by simply defining the pain.
M54.51 vertebrogenic back pain is to identify pain that is related to a vertebra / the spine. It does not specifically identify the exact disease or condition. One example is vertebral endplate pain. Some codes would or could be more specific to the spinal nature of pain in the lower back, such as sprain, strain, radiculopathy, etc., which can be used for a more specified identification; but this code is a generic version to indicate broadly spine related.
M54.59 other back pain would be used if the specific cause can be identified, but otherwise has no specific code. Unlike codes that state "unspecified," this code means you can specify the origin. For example, internal or visceral causation, such as a kidney stone causing back pain, would be an appropriate use of this code.
While it is likely most insurance payers would allow and pay for any of the three new back pain codes, be sure that if you utilize M54.51 or M54.59, you include information to support use. It is a good standard to remember that often the best answer is the simplest.
Another Code for Headache
There is also an additional, less publicized (but equally important) covered diagnosis for acupuncture. There is a new code for headache: cervicogenic headache G44.86. This code represents a further identification of the types of headaches, specifying cervicogenic as an origin or cause. Note there are multiple codes for headaches including specific diagnoses: migraine, tension, traumatic, vascular, cluster, etc.
Cervicogenic relates to pain that develops in the neck, although it is felt in the head. Cervicogenic headaches are secondary headaches, meaning there is specific underlying causation from the neck, which may include muscle tension.
Specific Codes for Cough
There were also updates to codes for cough that identify cough with greater specificity. While these codes are not typically used for reimbursement, there may be instances in which identifying a complication or comorbidity can identify barriers to a patient's recovery. The new codes for cough are as follows:
Other Considerations
It is important to always verify that your codes are current and to the highest level of specificity. This is a fancy way of saying: If you are diagnosing back pain, you need to now have five characters instead of four; just like in 2020, when the headache code went from three to four characters.
The latest updated codes became effective on Oct. 1, 2021, which means any date of service on or after that date must use the new code. Dates of service before Oct. 1, 2021, would require the older version. The date of service determines the code, not the date the service is billed.
Overall, there are now 72,748 ICD-10 codes for 2022 with 159 codes added, 32 codes deleted, and 59 revised. This article was limited to discussion of the codes that have implications for acupuncture providers.
Editor's Note: Have a billing question? Submit it to Sam via email at sam@hjrossnetwork.com. Submission is acknowledgment that your question may be the subject of a future column. For more information about billing for acupuncturists, listen to Sam's recent interview with Dr. Nell Smircina, available now in our online webinar archives.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
| Digital Exclusive
One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
| Digital Exclusive