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ICD-10 Structure & Fundamentals
July 17, 2015
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.
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.
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.
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.