The “End of Flexibility” for ICD 10

Unspecified Codes Now Result in Non-payment.

When ICD-10 implementation began in October 2015, most payers accepted any diagnosis code in the correct family of codes.

As of October 2016, diagnoses must be coded to the highest level of specificity. This means unspecified codes will be rejected and the claims not paid. If a code does not exist, always use the diagnosis code with ‘other’ rather than ‘unspecified’ in the description.

Deleted & Added Codes to Help with Specificity

Many are applicable to Chiropractic; most deletions and additions were related to cardiology.

  • TMJ – deleted 3 codes (M26.6X), added 12 codes in the new family M26.6XX.
  • Added 20+ codes for cervical disc disorder and degeneration, all in the M50.0XX, M50.1XX, 50.2XX, M50.8XX family.
  • Added sprain of jaw codes, S03.41XX, S03.42XX

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