How to Find Medicare Approved ICD-10 Codes for Chiropractic

As we get nearer to the big day, some chiropractors are a bit overwhelmed with the sheer number of options presented to them with ICD-10 codes. While ICD-10 certainly does increase the total number of codes possible, most chiropractors will only use a small fraction of them.

One key, then, to preventing ICD-10 overwhelm is to shrink the big list of possible ICD-10 codes down to a manageable set of probable ICD-10 codes. In this respect, an easy way to do this is to begin with codes that are approved for payment.

Fortunately, Medicare has already published a list of ICD-10 codes that are “approved” and using this list can give us a head start on shrinking down our ICD-10 codes list. The other advantage to using Medicare’s list is that most payers formulate their payment decisions based on Medicare policy, so a commercial payer’s list of approved codes (even though not publicly published like Medicare’s) will typically resemble Medicare’s list.

Word of Warning: just because an ICD-10 diagnosis code is on Medicare’s list does not automatically mean that the code must be on private payer list, nor that the payer would be obligated to pay for a service rendered with that diagnosis. But since the private payers rarely publish their “approved”list, utilizing Medicare’s list gives you a head start.  

Accessing Medicare’s Approved Codes

The place to find this list of approved diagnosis codes lives inside what is known as the Local Coverage Determination (LCD) policies used by your Medicare carrier. (ex: Noridian, WPS, Novitas, etc)

Although most carriers have a very similar looking set of LCD’s, Medicare does permit each individual carrier to interpret their rules for themselves, so there may be a slight variation in LCD’s approved by one carrier in one region of the country as compared to another.

Here’s what to do next:

  1. Go to YOUR Medicare carrier’s website
  2. Choose Part B, which is where chiropractic services are covered
  3. Choose your state or jurisdiction that contains your state
  4. Look for a link or tab that gives Local Coverage Determinations (LCDs) or LCD Policies
  5. Find the policy related to Chiropractic Services
  6. If you are doing this research prior to October 1, choose FUTURE LCD’s to access the policies; if you are doing this research after October 1, choose ACTIVE LCD’s
  7. Once inside the LCD document, you find the approved list of LCD codes
  8. Print out that list as a starting point to create your shortened list of approved ICD-10 codes!

Please Note: the order of the steps above may vary slightly for each Medicare carrier’s website. Using these concepts, we were able to access the LCDs for each carrier. If you cannot find the LCD policies for your carrier, please contact the carrier – not us – as we have no control over their website, its access or its updates.

 

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