ICD-10-CM 2021 Coding Updates for Chiropractic

September 29th, 2020 - Wyn Staheli, Director of Research

Categories: Chiropractic Diagnosis Coding

October 1st is just around the corner and that means it’s time for updates to the ICD-10-CM code set. For 2021, there are 490 new codes, 58 deleted codes and 47 changed codes. Most years there aren’t many significant ICD-10-CM code changes which affect chiropractic offices. However, this year there are some interesting changes such as a new headache type, new codes related to TMJ, and several new codes for reporting accidents involving micro-mobility devices (e.g., hoverboard).

New Temporomandibular Joint (TMJ) Codes

The following codes have been added:

Arthritis of temporomandibular joint;

M26.641 right

M26.642 left

M26.643 bilateral

M26.649 unspecified

Arthropathy of temporomandibular joint;

M26.651 right

M26.652 left

M26.653 bilateral

M26.659 unspecified

New Headache Codes

Code R51 was expanded to separate out an orthostatic headache (R51.0) from other headaches. An orthostatic headache, also called a positional headache, is a type of headache a patient experiences while standing (vertical position). It is relieved when the patient lies down (horizontal position) for a period of time (e.g., 20-30 minutes). This symptom code is used when there is not a more clear diagnosis of the cause of the headache (e.g., intracranial hypotension, migraine). If the headache cause remains unclear, use the unspecified code (R51.9)

Code R51 was previously grouped by some MACs as a secondary diagnosis with a short duration and it is anticipated that both expanded codes will also be assigned a short duration. However, it could be argued that an orthostatic headache might require more treatment. We have marked both as short duration in the 2021 ChiroCode DeskBook, but watch for further instructions from payers about this change. As of the date of this article, this change was not addressed in either an LCD or Article.

Accidents Involving Micro-Mobility Devices (e.g., Hoverboards)

Micro-mobility devices are small vehicles which typically travel less than 25 km/h (15 mph). The number of accidents involving micro-mobility devices such as electric bikes, hoverboards, and segways has increased dramatically over the last few years. A request was made to be able to track these kinds of accidents. While many health insurance payers presently do not require the use of External Cause Codes such as these, they might be requested for accident insurance claims. Codes such as V00.841 “Fall from standing electric scooter” might become fairly common in your practice.

There are 123 new codes just to describe these kinds of accidents. The following sub-categories have been added:

Type	Traffic Accident	Nontraffic Accident	Unspecified
Pedestrian on standing micro-mobility pedestrian conveyance injured in collision with;
pedal cycle	V01.13-	V01.03-	V01.93-
two- or three-wheeled motor vehicle	V02.13-	V02.03-	V02.93-
car, pick-up or van	V03.13-	V03.03-	V03.93-
heavy transport vehicle or bus	V04.13-	V04.03-	V04.93-
railway train or railway vehicle	V05.13-	V05.03-	V05.93-
other nonmotor vehicle	V06.13-	V06.03-	V06.93-

Other ICD-10-CM Code Changes to Note

Osteochondrosis, juvenile

Osteochondrosis is a bone growth disorder involving the developing growth plate and one or more of the surrounding ossification centers (epiphyses) which primarily occurs in children and is caused by a variety of factors (i.e., genetics, injury, repetitive trauma/overuse, vascular abnormalities, mechanical factors, hormonal imbalances). It is characterized by degeneration or necrosis followed by revascularization, regeneration, and recalcification. Symptoms include varying levels of discomfort, pain, or even disability.

The following sub-categories were added:

M92.50- Unspecified juvenile osteochondrosis

M92.51- Juvenile osteochondrosis of proximal tibia

M92.52- Juvenile osteochondrosis of tibia tubercle

M92.59- Other juvenile osteochondrosis of tibia and fibula

Other Specified Site/Joint Additions

The option to report an “other specified site” was added to several subcategories which include the following new codes:

Articular cartilage disorders: M24.19
Disorder of ligament: M24.29
Osteoarthritis: M19.09, M19.19, M19.29
Rheumatoid arthritis: M05.7A, M05.8A, M06.0A, M06.8A, M08.0A, M08.2A, M08.4A, M08.9A

The option to report an “other specified joint” was added to several subcategories which include the following new codes:

Ankylosis: M24.69
Contracture: M24.59
Derangement: M24.89
Dislocation: M24.39, M24.49
Other (instability, pain, stiffness): M25.39, M25.59, M25.69

ICD-10-CM Official Guidelines for Coding and Reporting

It should be noted that the ICD-10-CM Official Guidelines for Coding and Reporting include several new instructions, some of which relate to the reporting of COVID-19. These instructions are primarily about the reporting of symptoms and treatment for those symptoms — which doesn’t really affect many chiropractic offices. CLICK HERE to review the complete guidelines.

Other Code Set Updates

There are also some updates to CPT and HCPCS, the most significant of which are the changes to Office or Other Outpatient Services. These changes are included in the 2021 ChiroCode DeskBook as well as the new Evaluation and Management Comprehensive Guide publication which are currently shipping.

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