ICD-10 Coding for Chiropractic Subluxation(M99.01, M54.5)
Complete ICD-10-CM coding and documentation guide for Chiropractic Subluxation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chiropractic Subluxation
M99.0-M99.09Primary Range
Segmental and somatic dysfunction
This range includes codes for segmental and somatic dysfunctions, which are central to chiropractic diagnoses.
Dorsalgia
These codes are used for back pain and related symptoms, often secondary to subluxation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M99.01 | Segmental and somatic dysfunction of cervical region | Use when cervical subluxation is confirmed through PART criteria. |
|
| M54.5 | Low back pain | Use when low back pain is present without confirmed subluxation. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 codes for chiropractic subluxation
Essential facts and insights about Chiropractic Subluxation
Primary ICD-10-CM Codes for chiropractic
Decision Criteria
clinical Criteria
- Presence of asymmetry and restricted motion in cervical region
Applicable To
- Cervical subluxation
Excludes
- Cervicalgia (M54.2)
Clinical Validation Requirements
- Palpation reveals asymmetry at C5-C6
- Restricted left rotation (≤45°)
Code-Specific Risks
- Incorrect documentation of PART criteria can lead to denials.
Coding Notes
- Ensure documentation supports subluxation with at least two PART criteria.
M54.5 - Low back pain
Use when low back pain is present without confirmed subluxation.
Applicable To
- Lumbago
Excludes
- Subluxation (M99.03)
Clinical Validation Requirements
- Patient reports sharp, intermittent pain in L4-L5 region
Coding Notes
Ensure pain is documented with specific location and characteristics.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Cervical radiculopathy
M54.12Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Chiropractic Subluxation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M99.01.
Impact
Clinical: May lead to incorrect diagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use templates with PART criteria prompts., Regular training on documentation standards.
Impact
Reimbursement: Claims may be denied or underpaid., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on treatment provided.
Mitigation Strategy
Verify the number of regions treated and select the appropriate CPT code.
Impact
Failure to document all required elements can lead to audit findings.
Mitigation Strategy
Use comprehensive templates and conduct regular audits of documentation.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Chiropractic Subluxation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chiropractic Subluxation
Use these documentation templates to ensure complete and accurate documentation for Chiropractic Subluxation. These templates include all required elements for proper coding and billing.
Chiropractic adjustment for lumbar subluxation
Specialty: ChiropracticRequired Elements
- Subjective findings
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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