EFFECTIVE TODAY, OCTOBER 1st 2015
Massage Insurance Billing Update
Diagnostic Codes: ICD-9 to ICD-10 CM Codes
I am sending this notice to all massage practitioners who accept physician referrals and who are billing insurance for their services. This includes all FSMTA Members and all who have purchased any of my insurance billing related products or who have taken my seminars over the years. (That is; those with email addresses that are still valid or who have not un-subscribed). IF you, or someone you know, wishes to continue getting e-newsletters from me please sign in on my newly revised website: www.massageinsurancebilling.com
While this is quite lengthy, it is NOT all you need to know but it is a summary of the many avenues I have studied to get to this point to share with you.
I sincerely apologize that I have not updated anyone on ICD-10 Coding to this point. I have attended 4 webinars on ICD-10 Coding trying to understand and obtain information on this new coding system. I purchased the AMA ICD-10 Code Book, and received copies of others work in putting it all together. I figured if it’s that much of a pain for me I could just imagine what some of you are going through. Therefore I am providing you with GENERAL info you will need to bill for patient visits today forward.
NOTE: There are NO Changes to the CPT Procedure & Modality Codes
OCTOBER 1st is now here as is the need to be utilizing ICD-10 CM Diagnostic Codes for any insurance billing you do or plan to do.
Keep in mind that only physicians can diagnose a medical condition. Since that is a fact, only the treating physician can provide ICD-10 CM Codes to a massage therapist with a prescription written on or AFTER OCTOBER 1st. 2015. So be sure to get NEW SCRIPTS from treating physicians beginning today. Be patient with them as they too are likely to be going nuts about now…
You cannot have a September date with ICD-9 Codes and ICD-10 Codes on the same Claim Form. Therefore, if you have a patient visit your office on the 29th of Sept. and they come in again on October 1st your script and documentation must be billed, and submitted on two separate Claim Forms utilizing the correct codes for each time period.
You must be 100% sure that your documentation denotes the body region(s) prescribed in the ICD-10 Diagnosis Codes. As I have always said, if the notes, the script and claim forms do not match expect to be denied!
HERE is a couple of website links I have pulled together for you to cross -link the ICD-9 Codes with the new ICD-10 Codes to get an idea and understanding and descriptions of the ICD-10 codes a physician writes on a prescription. Warning, again, do not use these sites to convert a 9 to a 10 code. A physician MUST do that on a prescription. For you to do it is diagnosing and out of our scope of practice!
Following is an example of what converting ICD-9 Codes to ICD-10 will look like using the links above.
Convert ICD-9-CM 724.1 to ICD-10-CM
ICD-9-CM 724.1 converts directly to:
- 2015/16 ICD-10-CM M54.6 Pain in thoracic spine
Source: 2016 ICD-10-CM CMS General Equivalence Mappings.
I am including a slightly and temporary revised Prescription/ Letter of Referral deleting the ICD-9 Codes that are on script in my manual/forms on CD. I have also added a few more OTHER: ________________ lines for physician to include correct ICD-10 CODE. Once we have a better handle on what ICD-10 Codes relate to in precise body regions we normally perform massage therapy to I will further update the script with the proper ICD-10 Codes and resend to you.
For those of you who already have my latest manual (Revised 1st of May, 2014) you already have the instructions on how to complete the new Claim Form that has been required for billing since April 2012. Those new Claim Forms are also available on my website: www.massageinsurancebilling.com
MORE IMPORTANT INFORMATION
From all I can learn most all auto carriers will be switching to ICD-10 as well as FL Workers’ Comp. 22 State’s Work Comp Systems will be switching to ICD-10 beginning today, Oct 1st.
Remember in FL even though we cannot accept PIP cases, some of the carriers ARE paying for manual therapy provided and billed by an LMT. YOU RISK it if you take that chance and are ever asked for the money back, remember I never suggested you do it!
However, in a state that is so loaded with tourists, many of them get into accidents and their home state insurance WILL cover treatment provided by an LMT when prescribed by treating physician.
Also: you may take a Letter of Protection (LOP) AFTER the initial PIP $10,000 has been exhausted if you are willing to help the patient and wait and take a chance your fees MAY be lowered from time to time. So ALL access to billing doors are NOT closed. Some health plans and FL Workers’ Comp still pay. Just don’t abuse them by over billing.
The ICD-10 Codes that the system converts ICD-9 to is not all there is to billing under the new system.
A D or S which to use? This is also referred to as the “7th” Character.
Right now, I have an ICD-9 diagnostic code 784. “Headache”
2015 ICD-9-CM Code 784.0[convert to ICD-10-CM]
Converted to : · 2015/16 ICD-10-CM R51 Headache
Then comes the 7th Character, in this case “A”.
Add the Initial encounter 7th Character "A" = CM R51A because it would be my first encounter in receiving treatment.
OR finalized as: S CM R51 A
The “S” designates that the diagnoses relates to “INJURY” is for Injuries, poisoning , and other certain consequences of external causes related to single body regions.
The “A” designates the initial encounter.
HOWEVER if this becomes an ongoing condition and the physician refers me to a PT (or MT) it would be cause to use the letter “D“ as the 7th Character.
Rehab therapy would be reason to use “D” because means that would be considered part of the recovery and healing phase. So you would code for “SUBSEQUENT” encounter, thus assigning the 7th Character “D”.
Personally I think that is so stupid to use D instead of S for Subsequent but hey, ya know, we are dealing with Government again. LOL, so do I sound like The Donald?
Go to www.cms.gov for more complete information on the letters A D and S.
Thank you all for helping me as I actually learned more putting this letter together than in all the studying I have done on this the past year!!
Happy Coding!! UGH!!
Call me if you have questions or email. BUT , PLEASE do not expect an immediate response as I am swamped with calls right now. I will get to you as soon as possible but if I do NOT in a day or two please recall or resend email.
Return often for Insurance Billing Concerns and ICD-10 Coding info
because this is an ongoing, ever-learning process for all medical providers.
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