ICD-10 Structure & Fundamentals

ICD-10 codes are organized into chapters, separated by body system or condition, just like ICD-9. Chiropractors will mostly use codes from the following chapters of the official Tabular List, which is abridged in ChiroCode’s ICD-10 Coding for Chiropractic book: Chapter 6 (G Codes – Diseases of the Nervous system), Chapter 13 (M Codes – Diseases of the Musculoskeletal System and Connective Tissue), Chapter 18 (R Codes – Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified), Chapter 19 (S Codes - Injury), and maybe Chapter 20 (V, W, X, and Y Codes –External Causes of Morbidity).

ICD-10 codes contain up to seven characters and they contain numbers as well as letters.

• The first 3 characters are the category; all codes in the same category are a related condition (i.e. M47 is the category for Spondylosis).

• The next 3 characters provide detail about things like the anatomical site and severity; in some cases, they may be replaced by the “x” to ensure that the 7th character remains in the seventh position.

• Be careful about specifying the difference between the number zero “0” and the letter “O”. The same is true of “1”, “L”, and “I.”

• The 6th character frequently denotes laterality (1=right; 2=left). When there is no bilateral code, you need to list the right and left code separately.

• The 7th character for certain injury codes (encounter or episode of care) will usually only be used by chiropractors for sprain and strain codes (i.e. S23.3xx_ Sprain of Ligaments of Thoracic Spine.) The “_” underscore in the ChiroCode ICD-10 book indicates that a seventh character is required. They usually include the following three options.

1. o A – Initial encounter; patient is receiving active treatment. Payers may recognize this as a phase of care, rather than a single visit. It may be required when establishing medical necessity for chiropractic care.
2. o D- Subsequent encounter, routine care during the healing or recovery phase/support care. This may be considered appropriate for all visits after the initial visit, or it may be viewed as maintenance care.
3. o S – Sequela, complications or conditions that arise as a direct result of the condition. This would be applied to a condition which is no longer present, but it led to another problem, which is the primary reason for the encounter.

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