Samuel A. Collins
| DIGITAL EXCLUSIVE
Changes are always occurring, and this year is no different. As I was taught by my father, “Health care professionals are in practice and not in perfect,” and for that reason, acupuncture providers always continue to learn, update and change.
As I am sure many of you are aware, diagnosis coding updates occur every October 1st. In fact, although they are next-year changes (in this case, 2024), their effective date is Oct. 1 of the year prior.
The total number of diagnosis codes exceeds 70,000; in fact, the exact number is 73,764 specific diagnoses. For 2024, there are 526 new codes, 22 revisions and 25 deleted codes. This number is actually small compared to 2023; the 2023 update had 1,176 new codes and 287 deletions. However, what I always consider the important factor is how many codes affect common acupuncture coding. For instance, in previous years there were updates on lower back pain, headaches, myalgia, and cervical spinal disc conditions.
Bear in mind that acupuncture providers in some states may be prohibited from making a differential diagnosis, but certainly are indicating some specific conditions. In addition, a patient who is referred will have a diagnosis and it is imperative to understand that diagnosis to best care for your patient.
Chronic Migraines
This year's updates have no revision to any common codes that affect acupuncturists, but do have some additions to migraines, which are certainly conditions treated by acupuncture providers and specific to payment from major insurance payers. There are four new migraine diagnosis codes to describe chronic migraines.
Chronic migraines are noted by the Cleveland Clinic. Chronic migraine symptoms are the same as those of episodic migraines, but chronic migraines last longer or happen more often. These new codes would relate to at least 15 episodes in a month of a headache or migraine and at least eight of the days including migraine features. This would be present for at least three months.
The four new codes are.
- G43.E01 Chronic migraine with aura, not intractable, with status migrainosus
- G43.E09 Chronic migraine with aura, not intractable, without status migrainosus
- G43.E11 Chronic migraine with aura, intractable, with status migrainosus
- G43.E19 Chronic migraine with aura, intractable, without status migrainosus
Intractable migraine, also referred to as status migraine or status migrainosus, is a severe migraine that has continued for more than 72 hours and has been refractory to usual therapies for migraine. Essentially, a headache that does not go away where intractable indicates periods of no headache though may be recurring.
These new migraine codes add a greater level of specificity to describe migraines, which is already a large group of codes in the G43 category. “Chronic” now has its own set and further specifies that diagnosis by answering the intractable/not intractable and status migrainosus questions.
If have never researched the vast array of migraine codes, do a search of G43 – there are some 50 variations. Certainly you can provide much more detail than simply defaulting to R51.9 for “headache.”
As far as common codes used for conditions related to acupuncture care, this in my opinion, is the breadth of this year's update. That being said, there are a few other updates that may also play a role as far as complications or comorbidities when accompanied by other conditions treated by an acupuncturist.
Parkinson’s Disease
For example, the code updates include five new codes to report Parkinson’s disease (G20), which will boost specificity (granularity) by adding information about dyskinesia and fluctuations.
The standard global Parkinson’s code (G20) was deleted, with the following new additions:
- G20.A1 Parkinson's disease without dyskinesia, without mention of fluctuations
- G20.A2 Parkinson's disease without dyskinesia, with fluctuations
- G20.B1 Parkinson's disease with dyskinesia, without mention of fluctuations
- G20.B2 Parkinson's disease with dyskinesia, with fluctuations
- G20.C Parkinsonism, unspecified
Patients with Parkinson’s disease commonly experience recurring and chronic lower back and spinal pain (often due to posture, falls, etc.), and this underlying condition complicates and retards recovery of spinal pain conditions.
Resistant Hypertension
There is also a new code for resistant hypertension. This is defined by blood pressure above the patient's goal despite the use of three or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. This new code is I1A.0 Resistant hypertension. A patient may need other approaches than medication alone, including diet, lifestyle and acupuncture.
There are also multiple new codes related to the entering of a foreign body into a natural orifice. I will leave that one alone and simply note you may find some amusement by doing a search in the W44 category.
It is always important to be abreast of code changes and have a resource to assure your coding knowledge and use is current and best practice. Note that there are large lists of common payable codes by acupuncture providers and specific to paid claims; contact me if you are interested.
