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.
The next version – ICD-11 are already on the way. In May 2019, ICD-11 will be presented at the Seventy-second World Health Assembly for endorsement by Member States. In January 2022, Following endorsement, Member States will begin reporting health data using ICD-11. (WHO timeline)
ICD-9-CM codes were 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 and there are 69,000 codes to better capture specificity.
- 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-M25 Arthropathies(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.
A: Initial Encounter – Patient is receiving active care. You can use A on multiple claims for the same condition – it really isn’t just for the first encounter. “A” code for initial encounter is used for all sessions related to the “active” treatment for the symptoms called out in the ICD10 code.
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. Rehab therapy is usually considered to be part of the healing and recovery phase. The “D” code is used for subsequent treatments to check on the patient/client after active treatment is completed.
S: Sequelae — Complications or conditions that arise as a direct result of the condition that are caused from the direct result of an injury or condition. - Fractures have a different extension code than other conditions based on open vs. closed, routine vs delayed healing, non-union or malunion.
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. It is best to get the actual code from the doctors so that you can put the same code on the bill as the doctor does to tell the insurance that you are working on the same condition. Often times there are a variety of codes that can be used for one condition so it is important to know which one the doctor is using. 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
- 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
There are specific codes just for pain. It has been previously said that massage therapists can use pain codes to bill the insurance without a prescription. I have never seen a health care plan that does not required massage to be medically necessary which means a prescription is needed. Pain needs to be carefully diagnosed to rule out more severe injuries or conditions like heart attacks, kidney stones etc. 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 and tracking the codes will provide data for various conditions to see what therapies work best.
There is much more to billing insurance then just putting an ICD-10 code on a bill. Learn to bill insurance and see my plan to get massage therapy covered by health insurance in every state in my book : Massage Insurance Billing.
Other resources:
Originally written Aug 6th 2015. Updated Jan 30 2016, Updated 05/25/2019
Joe Arellano says
Thank you for your effort in putting your guide together. JA
Thomas Schaedel says
Massage therapy is a new program we have at Indiana Health Group, and we are wanting our clients to be able to make reimbursement claims to their insurance or be able to have what they need for their HSA. Looking forward to the ICD-10 codes 🙂
Julie Onofrio says
The ICD 10 codes are in effect now. To get massage covered by insurance is a whole other thing. You will need to work with the State’s Office of the insurance commissioner to get them to implement 2706 of the ACA and make them make insurance cover you. You will need lawyers, lobbyists etc.
See my other articles on this – https://www.massagepracticebuilder.com/healthcare-integration-for-massage/
terry says
Hi Julie,
Why is there an * next to the two sciatica codes? I haven’t had any issues with claims getting covered except today I had 3 that didn’t go through (office ally)
One was a 724.3 converted I used M54.30 (sciatica) but I see another one with Lumbago. Thanks for posting!
Julie Onofrio says
I just copied the codes from the website -http://www.roadto10.org/action-plan/phase-2-train/common-codes-orthopedic/ – here is what they say “*Codes with a greater degree of specificity should be considered first.”
Jacquelyn says
Hi, I too am trying to get the new codes to use for my clients , my city in the state I’m licensed to do Massage Therapy covers their employees for a once a month massage. I don’t have the new codes. Looking for this and would appreciate any help in doing so.
Thank You,
Jacquelyn. LMT
Julie Onofrio says
the doctor will give you the new codes. Call their office and have them update the script and put the new codes or just get the new codes. You can also convert the old ones using the ICD 10 converter linked in the article.
Rosi says
Thank you, Julie, for putting this together. I have doctors prescriptions for MXX.X… (pain codes) and SXX.X… (injury codes). Your post helped me clarify these are ok. For the same patient, another doctor’s office wrote one uncoded prescription and another with codes that, from your article, don’t appear to be OK for massage treatment: F07.81 (post-concussion syndrome) and V43.52 (car driver injured in a collision) and R51 (headache). Yes we treat musculoskeletal dysfunction that might give rise to headaches, but this code doesn’t begin with M.
Will those three codes be rejected by the patient’s insurance? Should I ask the doctors to only prescribe by M and S codes? Or is that arrogant of me to ask from a doctor? I am billing under 97140, and mostly doing craniosacral and myofascial release work, with some Ortho-Bionomy.
Thank you!
Steve says
I Believe some Massage Therapist have surpassed many of the Physical Therapies out there and will not be recognized by the Medical field due to perception of a Generic word. I could go up against many Physical Therapist. Have Quicker and Better Results. But my work will not be recognized by Insurance companies. Orthopedic Massage and Medical Massageneed their own Codes.
Julie Onofrio says
Actually professions do not have their own codes. A CPT code can be used by any profession that can use it depending on their scope of practice laws. Massage therapy is already being recognized by health insurance in WA State and has been for over 20 years.
Louis says
Hi Julie,
Using office ally to bill an MVA requires an ICD code, in Oregon patients can self-refer. If diagnosing ICD codes are beyond the scope of practice how does one submit a CMS 1500 form? Another instance is a doctor giving a report that says “whiplash” or “right shoulder pain” on it with no diagnostic code next to it, the only ICD code was not billable. Do we have the scope to extrapolate the codes from this?