Question: When do the 2023 diagnosis codes update? I want to make sure my claims aren't denied.
As always, diagnosis code updates took effect on Oct. 1; this time, there are 1,176 new codes, 28 revised codes and 287 deleted codes. The total codes now in ICD-10-CM is 73,639 – that's a lot of codes!
Last year, we did have a major update to lower back pain, which is the most commonly billed code for acupuncture reimbursement, so that was a really big deal. For 2023, there are no major acupuncture-centric changes for coding; however, there are some codes that may be of importance for acupuncture providers to be aware of.
Lower Back / Disc
For lower back, there is an update with new codes specifically for annulus fibrous defect (disc) of the lumbar and lumbosacral spines. Of course, these are not likely common codes for you, but for chronic lower back patients this code may come up when they have had MRI or CT scans.
Of course, at the end of the day, the symptom is lower back pain, so it worth being aware that there are additional disc codes. Note that CIGNA, UnitedHealthcare and Anthem will cover codes that relate to lower back pain, such as disc-related diagnosis.
These new codes are as follows; note that they do not replace any codes, but are simply more specific diagnoses:
Keep in mind that plans like Aetna and Oscar will not accept these codes; and you still relate the symptom to lower back pain M54.59 Other specified lower back pain.
Muscle Wasting / Atrophy of the Spine
There are also new codes for muscle wasting and atrophy of the spine. Again, these are not likely typical codes, but still important to be aware of and certainly apply to complicating factors in neck or back pain that could prolong and enhance the need for care.
Endometriosis
Endometriosis is a common condition and one that may cause a great deal of pain. While it may be more likely to code as abdominal pain, the codes for endometriosis were deleted and updated. The common code for endometriosis, N80.0 Endometriosis of uterus, was deleted and now is a set of five-character codes as follows:
In fact, there are now over 90 new codes that are six characters in length (N80.311 through M80.D9) that describe endometriosis relative to just about every structure in the pelvis and chest. I will not bore you listing them all, as likely you will focus on the pain aspect, but be aware the updated codes are five and six characters in length if you need to use one.
Post-Viral Fatigue
There is also a new code for post-viral fatigue syndrome: G93.31; and while not a code used directly for reimbursement, the identification of this condition will be a factor that will inhibit recovery of commonly treated acupuncture conditions.
Take-Home Points
Even with the above changes / updates, I believe for most of you there are no substantive changes from last year. But be careful of hyperbole, as yes, there are changes; but I will always focus on what is important and pertinent to the acupuncture provider. Do you need a new code book for 2023? Very unlikely.
One last note: Have you ever had a patient or known someone not getting the care they need because they cannot afford it? They have created a code for it for 2023: Z91.190 Patient's noncompliance with other medical treatment and regimen due to financial hardship.
This is the bridge I hope acupuncturists can provide to their patients: an affordable visit compared to the medical model. Complementary care has an important role for care that is not only effective, but also accessible and affordable. Best wishes for 2023!
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.
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