42
massage therapy journal
ALL THINGS ICD
If you bill insurance
or are considering it,
here’s what you need to
know about the newly
revised International
Classification
of Diseases.
BUSINESS
SAV V Y
The Centers for Medicare
& Medicaid Services has
coding resources on its
website, including an
ICD-10 CM “look-up” tool,
as well as information on
coding changes. For more
information, visit cms.gov,
click on “Medicare,” and
under “Coding,” click
on “ICD-10.”
Summer 2016
If you’re a massage therapist who bills insurance
contact the doctor for clarification. Massage
(which in itself can be a daunting task), you’ve
therapists should never change the code selected
likely been following the code set transition from
by the doctor.
ICD-9 (International Classification of Diseases)
to ICD-10 that began on Oct. 1, 2015.
For those who are new to insurance billing,
Making a Claim
State licensing laws control whether massage ther-
ICD codes are defined by the World Health
apists can bill health insurance for their services.
Organization as the standard diagnostic tool for
Massage therapists should fully understand the
epidemiology, health management and clinical
scope of practice in their state to make sure they are
purposes—including the analysis of the general
billing health insurance only for services within the
health situation of population groups. These codes
state scope of practice law. (Find information about
are used to monitor the incidence and prevalence
your state at amtamassage.org/regulation.)
of diseases and other health problems, which helps
documents, so massage therapists must collect
health situation of countries and populations.
and retain information supporting their
Put simply: These diagnostic codes are used
requests for payments. Typically, a claim file
by the client’s primary care provider when deter-
must have documentation to confirm that the
mining proper treatment and will appear on the
service was provided—at a minimum. Insurance
client’s prescription.
companies also usually require a doctor’s order
ICD-10 codes are different
from ICD-9 codes in several
ways, but the most important difference is they are
more specific than ICD-9
codes. In many cases, there
is more than one ICD-10
code for the previous ICD-9
T I M E LY
TIPS
Massage therapists
are not responsible for
determining a medical diagnosis. Only
primary care providers
with the legal authority
within their scope of
practice can diagnose
a medical condition.
Additionally, health insurance claims are legal
provide a more complete picture of the general
The Difference
Between ICD-9
and ICD-10 Codes
43
for a service before they
Massage therapists
must collect and
retain information
supporting their
requests for
payments.
code. Generally, ICD-10
will pay a claim, so make
sure you are familiar with
the requirements of the
insurance companies they
work with.
The accompanying chart
(pages 44–45) uses the
Centers for Medicare and
Medicaid Service’s general
equivalency mappings
(GEMS) to find the ICD10 Clinical Modification
codes require a high level of specificity. For exam-
(CM) codes that massage therapists would most
ple, if a client has a shoulder injury, the ICD-10
often encounter in their practice. Not all of the
codes require the health care provider to identify
codes listed fall within the scope of practice
whether the injury was to the left or right shoulder.
of massage therapy. Everyone within the health
Of course, massage therapists are not respon-
care community is getting comfortable with the
sible for determining a medical diagnosis for
new codes. This list can be used as a catalyst for
their clients. Code selection is the responsibility
discussion with the prescribing provider.
of the health care provider who is legally account-
Keep in mind that these codes are updated
able for establishing the patient’s diagnosis, usually
periodically—adding, deleting and/or refining
a physician or a physician extender, such as a nurse
codes and descriptors. Staying up to date with
practitioner. If a massage therapist has questions
new codes can help facilitate claims processing
about the diagnosis a doctor selects, they must
and reimbursement.
AMTA
RESOURCES
AMTA is always working
to keep you up to date
with resources that
can help you build your
practice and take better
care of both your clients
and yourself. For more
great information, visit
the Career Guidance
section of AMTA’s website
at amtamassage.org/
careerguidance.
amtamassage.org/mtj
44
massage therapy journal
ICD-10 CODES
ICD-10 CODE
ICD-10 CODE DESCRIPTION
ICD-10 CODE
ICD-10 CODE DESCRIPTION
M25.419
Effusion, unspecified shoulder
M79.646
Pain in unspecified finger(s)
M25.411
Effusion, right shoulder
M25.412
Effusion, left shoulder
M25.559
Pain in unspecified hip
M25.551
Pain in right hip
M25.429
Effusion, unspecified elbow
M25.552
Pain in left hip
M25.411
Effusion, right elbow
M25.422
Effusion, left elbow
M25.569
Pain in unspecified knee
M25.561
Pain in right knee
M25.439
Effusion, unspecified wrist
M25.562
Pain in left knee
M25.431
Effusion, right wrist
M25.432
Effusion, left wrist
M25.579
Pain in unspecified ankle and joints of
unspecified foot
M25.449
Effusion, unspecified hand
M25.571
Pain in joints of right ankle and right foot
M25.572
Pain in joints of left ankle and left foot
M25.441
Effusion, right hand
M25.442
Effusion, left hand
M25.50
Pain in unspecified joint
M25.459
Effusion, unspecified hip
M25.619
M25.451
Effusion, right hip
Stiffness of unspecified shoulder, not
elsewhere classified
M25.452
Effusion, left hip
M25.611
Stiffness of right shoulder
M25.469
Effusion, unspecified knee
M25.612
Stiffness of left shoulder
M25.461
Effusion, right knee
M25.629
M25.462
Effusion, left knee
Stiffness of unspecified elbow,
not elsewhere classified
M25.621
Stiffness of right elbow
M25.473
Effusion, unspecified ankle
M25.622
Stiffness of left elbow
M25.471
Effusion, right ankle
M25.472
Effusion, left ankle
M25.639
Stiffness of unspecified wrist,
not elsewhere classified
M25.474
Effusion, right foot
M25.631
Stiffness of right wrist, not elsewhere classified
M25.475
Effusion, left foot
M25.632
Stiffness of left wrist, not elsewhere classified
M25.476
Effusion, unspecified foot
M25.649
M25.40
Effusion, unspecified joint
Stiffness of unspecified hand,
not elsewhere classified
M25.519
Pain in unspecified shoulder
M25.641
Stiffness of right hand
M25.511
Pain in right shoulder
M25.643
Stiffness of left hand
M25.512
Pain in left shoulder
M25.659
Stiffness of unspecified hip,
not elsewhere classified
M25.529
Pain in unspecified elbow
M25.651
Stiffness of right hip
M25.521
Pain in right elbow
M25.652
Stiffness of left hip
M25.522
Pain in the left elbow
M25.669
M25.539
Pain in unspecified wrist
Stiffness of unspecified knee,
not elsewhere classified
M25.531
Pain in right wrist
M25.661
Stiffness of right knee
M25.532
Pain in left wrist
M25.662
Stiffness of left knee
M79.643
Pain in unspecified hand
M25.673
M79.641
Pain in right hand
Stiffness of unspecified ankle,
not elsewhere classified
M79.642
Pain in left hand
M25.671
Stiffness of right ankle,
not elsewhere specified
M79.644
Pain in right finger(s)
M25.672
M79.645
Pain in left finger(s)
Stiffness of left ankle,
not elsewhere specified
amtamassage.org/mtj
Summer 2016
ICD-10 CODE
ICD-10 CODE DESCRIPTION
ICD-10 CODE
ICD-10 CODE DESCRIPTION
M25.674
Stiffness of right foot, not elsewhere specified
R59.9
Enlarged lymph nodes, unspecified
M25.675
Stiffness of left foot, not elsewhere specified
R59.0
Localized lymph node
M25.676
Stiffness of unspecified foot
R59.1
Generalized lymph node
M25.60
Stiffness of unspecified joint,
not elsewhere classified
S43.409A
Unspecified sprain of unspecified shoulder
joint, initial encounter
M54.2
Cervicalgia
S46.919A
M54.6
Pain in thoracic spine
Strain of unspecified muscle, fascia and tendon
at shoulder and upper arm level, unspecified
arm, initial encounter
M54.5
Low back pain
S73.109A
Unspecified sprain of unspecified hip, initial
encounter
M54.30
Sciatica, unspecified side
S76.919A
M54.31
Sciatica, right side
Strain of unspecified muscles, fascia and
tendons at thigh level, unspecified thigh, initial
encounter
M54.32
Sciatica, left side
S83.90XA
M54.89
Other dorsalgia
Sprain of unspecified site of unspecified knee,
initial encounter
M54.81
Other nueralgia
S86.919A
M54.9
Dorsalgia, unspecified
Strain of unspecified muscle(s) and tendon(s)
at lower leg level, unspecified leg, initial
encounter
M43.27
Fusion of spine, lumbosacral region
S33.6XXA
Sprain of sacroiliac joint, initial encounter
M43.28
Fusion of spine, sacral and sacrococcygeal
region
S33.6XXD
Sprain of sacroiliac joint, subsequent
encounter
M53.2X7
Spinal instabilities, lumbosacral region
S33.6XXS
Sprain of sacroiliac joint sequella
M53.3
Sacrococcygeal disorders,
not elsewhere classified
S13.4XXA
Sprain of ligaments of cervical spine, initial
encounter
M35.7
Hypermobility syndrome
S13.8XXA
Sprain of joints and ligaments of other parts of
neck, initial encounter
M62.81
Muscle weakness (generalized)
S23.3XXA
M60.9
Myositis, unspecified
Sprain of ligaments of thoracic spine, initial
encounter
M79.1
Myalgia
S23.8XXA
Sprain of other specified parts of thorax, initial
encounter
M79.7
Fibromyalgia
S33.5XXA
M79.609
Pain in unspecified limb
Sprain of ligaments of lumbar spine, initial
encounter
M79.601
Pain right arm
S33.5XXD
M79.602
Pain in left arm
Sprain of ligaments of lumbar spine,
subsequent encounter
M79.603
Pain in unspecified arm
S33.5XXS
Sprain of ligaments of lumbar spine, sequella
M79.604
Pain in right leg
M79.605
Pain in left leg
M79.606
Pain in unspecified leg
R60.0
Localized edema
R60.1
Generalized edema
R60.9
Edema, unspecified
G44.1
Vascular headache, not elsewhere classified
R51
Headache
45
Source: who.int/classifications/icd/en/ (Accessed January 2016)
amtamassage.org/mtj