by Wyn Staheli, Director of Research
September 9th, 2019
Some years there aren’t many changes and other years have quite a few. So far this year, there are quite a few coding changes for 2020 that chiropractors need to be aware of. Please note that at the time of this article, the HCPCS codes have not been released.
While there are not any significant changes to ICD-10-CM codes frequently used by chiropractors, there was an interesting change in Section 19.c of the Official ICD-10-CM Coding Guidelines. The following new guideline for growth plate fractures has been added:
3) Physeal fractures
For physeal fractures, assign only the code identifying the type of physeal fracture. Do not assign a separate code to identify the specific bone that is fractured.
While the bread and butter CMT codes remain unchanged, there are quite a few other changes that could significantly impact your reporting. Remember, these changes will take place effective January 1, 2020.
Dry needling: In January we reported that this change was coming. There are two new codes for dry needling or trigger point acupuncture in the “Surgery” section of the CPT codebook. The AMA also added new guidelines to code 97140 and the acupuncture codes (97810-97814) that you are to use the new codes for “dry needling or trigger point acupuncture”.
Health and Behavior Assessment/Intervention: Codes 96150-96152 have been replaced with nine new codes and there are some big changes to the guidelines. The code changes break out the services into individual, group, and family services as well as adding time-based reporting with add-on codes. They even include definitions of both an assessment and an intervention.
Health and Well-being Coaching: There are new Category III codes for specially-trained nonphysicians to help a patient achieve better health. These services cannot be reported with the Health and Behavior Assessment/Intervention codes.
Muscle testing: Codes 95831-95834 have been deleted but they aren’t replaced with any new codes. CPT guidelines say to use the physical, occupational, and athletic therapy evaluation codes 97161-97172 instead. It should be noted that the range of motion codes remain unchanged.
Online evaluations: Code 99444 for physicians and 98969 for nonphysicians have been replaced for 2020. The new codes and their associated guidelines include quite a few exclusions as to when these codes can and cannot be used. The biggest issue, which might be easily overlooked and that providers will need to watch for, is the potential to unintentionally “double dip” by over-reporting. For example, if there is an E/M visit within 7 days before or after an online evaluation, then you can NOT report these codes separately because the service is considered part of the E/M service. Reporting them separately would be considered “double dipping.”
More comprehensive information on these code changes is included in the 2020 ChiroCode DeskBook which is shipping soon. Watch for your renewal notice in the mail and be sure you order your copy today.