Yes ICD -10 codes are here and there is a lot of information that you will need to know. International Statistical Classification of Diseases and Related Health Problems codes are created by the World Health Organization and are used around the world. They are diagnosis codes that are used when doctors prescribe massage so you will need to be up on what is going on.
We are currently using ICD-9 codes which were created 35 years ago and are really out of date. The ICD 10 codes were created in 1990 and all of the other countries who use the ICD coding system are already using them. The US is way behind on this one.
The next version – ICD-11 are already on the way expected in 2017 or 2018. There was of course many controversies over this because changing the codes means that all the doctors and all of the computers need to be updated every time which is of course a major project. There was a lot of discussion saying that we should go right to ICD-11 but the rationale is that the ICD-10 is such a big change and is a foundation for the ICD-11’s.
ICD-9-CM codes 5 digits
- First digit is alpha (E or V) or numeric
- Digits 2-5 are numeric
- Decimal is placed after the third character
- 14,000 codes
ICD-10-CM codes are 7 digits
- Digit 1 is alpha.The two main category of codes massage therapists will see most of are the M and S codes:
M = musculoskeletal or connective tissue condition
S = injury or consequences of external causes
- Digit 2 is numeric
- (M00-M03) Infectious arthropathies
- (M05-M14) Inflammatory polyarthropathies
- (M15-M19) Arthrosis
- (M20-M25) Other joint disorders
- M40-M54 Dorsopathies
- (M50-M54) Other dorsopathies(M45-M49) Spondylopathies(M40-M43) Deforming dorsopathies
- M60-M79 Soft tissue disorders
- (M60-M63) Disorders of muscles
- (M65-M68) Disorders of synovium and tendon
- (M70-M79) Other soft tissue disorders
- M80-M90 Osteopathies
- M91-M94 Chondropathies
- M95-M99 Other disorders of the musculoskeletal system and connective tissue
- S00-T14 – Injury
- (S00-S09) head
- (S10-S19) neck
- (S20-S29) thorax
- (S30-S39) abdomen, lower back, lumbar spine and pelvis
- (S40-S49) shoulder and upper arm
- (S50-S59) elbow and forearm
- (S60-S69) wrist and hand
- (S70-S79) hip and thigh
- (S80-S89) knee and lower leg
- (S90-S99) ankle and foot
- (T00-T07) involving multiple body regions
- (T08-T14) unspecified parts of trunk, limb or body region
- Digits 3–6 are alpha or numeric
For “M” and “S” category codes, the side of the body is indicated. Generally:
- 1 = right
- 2 = left
- Note: There are a variety of different methods for denoting bilateral locations
- Decimal is placed after the third character
- 7th digit is a special extension code that will be alphabetical and is required for injury codes that start with S.
The “A” code for initial encounter is used for all sessions related to the “active” treatment for the symptoms called out in the ICD10 code. The “D” code is used for subsequent treatments to check on the patient/client after active treatment is completed
S80 Superficial injury of knee and lower legS80.0 Contusion of kneeS80.00 Contusion of unspecified kneeS80.00XA …… initial encounterS80.00XD …… subsequent encounterS80.00XS …… sequela
- A: Initial Encounter – Patient is receiving active care
- D: Subsequent Encounter -After patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.
- S: Sequelae — Complications or conditions that arise as a direct result of the condition
- Fractures have a different extension code than other conditions based on open vs. closed, routine vs delayed healing, non-union or malunion.
- For codes that are 3 to 5 characters, the place holder “x” is used to fill in the empty character fields with the extension code at the end. An example is:
- 69,000 codes to better capture specificity
Read more on the code structure at ICD-10 basics from www.roadto10.org
ICD-10 codes will provide specific locations for injuries. They will also document chronic or acute pain issues. The new codes are much more specific and will provide us with much more information about diseases and their treatments which will help with health management and research.
Since these are diagnosis codes and massage therapists can not diagnose clients, the codes will come from the doctor. The doctor may or may not write the actual description of what the code means so you may have to look the code up to know what it means. There are many free code look up databases online. See ICD 10 Look up from CMS.
Here also are some common orthopedic codes that are used for rehabilitation from Road to 10.
- M54.2 Cervicalgia
- M50.01 Cervical disc disorder with myelopathy, occipito-atlanto-axial region
- M50.02 Cervical disc disorder with myelopathy, mid-cervical region
- M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
- M54.30* Sciatica, unspecified side
- M54.31 Sciatica, right side
- M54.32 Sciatica, left side
- M54.40* Lumbago with sciatica, unspecified side
- M54.41 Lumbago with sciatica, right side
- M54.42 Lumbago with sciatica, left side
Here are common pain codes:
- Shoulder — M25.511 (R), M25.512 (L)
- Upper Arm — M79.621 (R), M79.622 (L)
- Elbow — M25.521 (R), M25.522 (L)
- Forearm — M79.631 (R), M79.632 (L)
- Wrist — M25.531 (R), M25.532 (L)
- Hand — M79.641 (R), M79.642 (L) (excludes fingers)
- Hip — M25.551 (R), M25.552 (L)
- Thigh — M79.651 (R), M79.652 (L)
- Knee — M25.561 (R), M25.562 (L)
- Lower Leg — M79.661 (R), M79.662 (L)
- Ankle — M25.571 (R), M25.572 (L) (excludes foot/toes)
- Foot — M79.671 (R), M79.672 (L) (excludes toes)
- Thoracic Spine — M54.6
- Low Back Pain — M54.5
As you can see, these codes are much more specific so that will give you so much more information.
You can actually start using these now and you should actually start using them now. You can start by just using it on like 10% of your clients to test the systems. You will have to ask the doctors to start supplying the codes. The reason for starting with them now is because we don’t know how all of the billing and insurance systems will work with handling the new codes although there has been extensive testing. There could be delays in processing as everyone starts using the new codes.
Originally written Aug 6th 2015. Updated Jan 30 2016