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Greetings, everyone. The coding and billing expert is here. Sam Collins, the American Acupuncture Council is your partner in success. The network is the other step of that. How do we help you? We make sure you’re getting paid for what you’re doing, and I don’t care if it’s insurance, cash or otherwise. One of the things to get updated on, of course, is diagnosis.
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As you’re well aware, diagnosis actually update every year, but here’s a riddle for you. When do the 2024 diagnosis codes update? You’re thinking, actually they already did diagnosis codes always update on October 1st, the year prior. So really the answer to the riddle is the 2024 diagnosis began October 21st.
Of 2023. What’s important to note though, is yes codes update, but do the codes update that are important to us, meaning the ones that you use regularly. So let’s talk about that. Let’s go to the slides. Let’s talk about what is going on for 2024. In fact, right now, what’s happening with ICD 10? ICD 10 is our coding system.
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It’s what we use to communicate what’s wrong with our patients. Now, you might say, SI, I don’t bill insurance. I don’t need to know a code. You better know a diagnosis. Whether you’re putting the code down or the diagnosis, it should be accurate. So by example, if I were to say someone has neck pain, that would be okay.
What’s another way of communicating that, whether it be a super bill or a 1500 claim form is AM 54 2. realize every code is universal. That I don’t care if you’re in China, if you put M 54 2, they know you mean neck pain. So we always have to use coding to make sure we have the best and most appropriate coding for what is wrong with our patient.
Diagnosis matters. It really is. What is wrong with your patient? Now, some of you might say Sam, I can’t diagnose in my state. If that’s true, although I’ll say some of that’s not quite, someone comes in with pain. You can say they have pain. You’re not differentiating it, you’re just saying pain.
But what diagnosis is what’s wrong with the patient? Why are they there? Now, what I love about acupuncture is the simplicity, but the genius of the simplicity of acupuncture. What does the body always communicate when something is wrong? It always tells us one simple thing, I’m hurting. I’m in pain. I don’t care what you have.
Pain is always gonna be part of that, so keep it simple. Pain is gonna be fine. For the most part though, we can go beyond that. That’s not all what man? Acupuncturists treat lots of things. Like by example, if you’re treating with someone under the insurance eviCore, they’ll pay for strokes. They’ll pay for menopause, they’ll pay for anxiety, depression, anorexia.
So there’s a lot more beyond. Acupuncture now is being recognized to do much more than just pain management, though. Pain management is a very popular thing to do. It’s not all that you do. So have to remember when we’re talking about coverage. Coverage for some insurances may be limited to pain. But it can be, go beyond that.
Here’s a couple of offices that just put up signs in front, and here would be a thing I’d have for you is do people know what you do? Like I drive by an office that says acupuncture. Great. So when you just put that up, what are you expecting? That I know Something that no one’s ever taught me. I. You’re hoping.
So here’s two offices that let people know what they treat. Notice this one is fatigue, stress, tension, anxiety, depression, so on it goes all these conditions. The other one even indicating like Bell’s palsy, start to think of, we’ve gotta educate people what you do, regardless of how you’re getting paid, whether cash or otherwise.
We have to tell them what we do. And every one of these things has a diagnosis. So that way, even if you’re in all cash office, can I give them a Super Bowl with a diagnosis to make sure we can potentially get the best possible payment by example? Here’s for Aetna. This is Aetna current. This is gonna change after first of the year a little bit, but right now you can see this is what Aetna covers.
Now what’s really interesting here, you’ll notice it says these are the codes that Aetna covers if the selection criteria is met. But then it says, not all inclusive. You know what that’s really saying? These are the codes we pay for sure. There’s others, but we’re not gonna tell you. But I would say, look at this and start to pick up.
Notice it says Migraines. So it covers migraines, but if you notice, you dropped out other types of headaches as well. Then back pain, hip pain. In other words, I’ll tell you, they cover pain, but more than beyond that. So it’s a matter of knowing do I have the right code? Here’s what’s happening with ICD 10.
We have to know that diagnosis code has to reflect what we’re seeing. I would say the most common codes, pain symptoms and signs, they’re acceptable. Probably the best payable codes often, but we have to know. Wait a minute, Sam, you’re talking about an update. I know. I. So let’s talk about the updates. Every year there’s an update and as noted, the ones change for this year, October 1st.
Now, frankly, I will tell you I’m very acupunc centric when it comes to this. I really don’t care about things that acupuncturists don’t manage, treat or get paid for. So if you told me something about nephrology, I go that may be an issue, but I’m not gonna worry about that change ’cause it’s not a code I’m probably going to be using.
So this year there were a lot of updates. You’re thinking, wow. We have 73,000 diagnosis codes. Think about that. There’s that many conditions. Yep. Now, let’s be mindful though. How many do you commonly do? I’m gonna say most acupunctures probably code 10 to 15 things. And it’s because we see a lot of the same things, or you specialize.
So we have to make sure are the things that I treat changing. So there are 395 additions, 25 deletions. What has changed that I can see that might affect you? Here’s one. Migraine. It was first on the list for notice. Now we have codes that indicate chronic migraine. And I know you might be thinking, Sam, there’s always been a code for a chronic migraine.
No, there hasn’t. There actually has not. There’s been codes for migraines, never identified as chronic. Now, what does chronic.
Chronic mean. Honestly, from a pure coding standpoint, chronic means a condition that is lasting longer than you would expect for it normally to be gone, or probably in simplest terms, 12 weeks. So a person that’s had migraines off and on for 12 weeks or more. It’s probably chronic. In fact, I would make an argument that most people that get migraines, they’re probably recurrent.
So I’m gonna jump in and say maybe most migraines, unless this is the first time the person ever had it, is probably chronic to an extent. What I’m pointing out there is just a way of coding it. Are you paid for migraines? You bet you are. Now, can you code headache? Instead of migraine? No, I guess you could, but I want you to think for a moment.
Let’s talk about insurances like an As, H or others. If you’re requesting 12 visits for headache, I doubt they’re gonna give it to you. They’re gonna think, come on, it’s a regular headache. Treat ’em a few times. But what if you code a chronic migraine? Does that set up something a little different? Think of a person with simple back pain.
That’s how you say it’s back pain. But they actually have . Disc bulging with radiculopathy. That is painful, but is disc. Disc with radiculopathy more serious? That’s a patient probably gonna treat for months. Here’s the idea. Give me the code that best describes what’s going on with the patient. So is this a big deal?
No, but it’s one to add to your arsenal. How many of you have a common code list? How many of you have been to American Acupuncture Council? Our network seminars, we provide you with a list. Of all the codes that are payable by insurance and in fact that list is further divided into which insurances do pay for some, which ones don’t pay for some, a good way to look.
But nonetheless, this is added to the list. They’re definitely covered. What else has changed for this year? Remember last year, not any big changes, but the year before, remember the back pain code change and you had all that back and forth. I’m gonna give you a quick tip. If you are billing a Medicare Advantage plan.
And your coding back pain, which of course that’s what they cover. It must be M 54 51 or M 54 59. Do not ever use M 54 50 for back pain. When it comes to anything related to Medicare, and I’m not talking just regular Medicare Part B, but I’m talking the advantage plans that pay you directly. This year migraine codes changed, but notice this code for Parkinson’s.
You’re thinking, oh, come on Sam, Parkinson’s. I won’t say acupuncture treats Parkinson’s directly, but what do Parkinson’s patients often have? Painful and stiff joints. Back pain. So I would look at this as being a comorbidity. I’m not treating it directly, but a Parkinson with Parkinson’s may have more need for care.
I’m not saying treating Parkinson’s at all, and I’m not saying I’m really worried about this coach, but should you be aware, will a Parkinson’s patients have some different issues if you’re dealing with an ASH and you’re requesting extra visits. These type of comorbidities are actually what they pay attention to that, oh, I see why this person needs a little bit more.
What about osteoporosis? M 54 51 is a code that indicates back pain. That’s vert, progenic. Might a person with vertebral genic or osteoporosis be part of that? Here’s some new codes for that are gonna be related to the pelvis. Now, again, I’m pointing out, you’re going, Sam. Do I really care about these?
Probably not in the sense of directly, but indirectly. Think of you’re treating the human condition. If it’s manifesting with some pain. There’s always a way to do that. What I’m concerned about though is what were the changes this year? Migraine. So if you don’t have an UpToDate list, you may want to get one.
Come to the American Acupuncture Council, the network. If you’re part of our network, if you come to our seminars, you get it if you have malpractice through us. Thank you. Malpractice is separate. If you come to my seminar, it doesn’t give you malpractice coverage, so we wanna make sure you have the right codes.
In an up-to-date list of information this year, are there any earth shattering changes? No, I would say not, because it doesn’t change codes that you’re already existing, that you’re doing. It’s adding some. So make sure, do I have the right and proper ones to identify what’s going on and what if they’re coming in from someone else and bringing that diagnosis.
I gotta make sure I have an accurate diagnosis and one that’s payable by example. Cigna has a different list in Aetna, which is different from United, which is different from progressive or other types. So keep in mind, know your coding, know where your payment’s coming from, the AC, the network. We’re always here to help you, but here’s one that’s interesting.
This one may not help you much, but this will be a fun one. At parties, there’s a diagnosis for everything. Do you know there’s a diagnosis for being a bad parent? The parent that’s hovers over the person too much that’s always there and always interferes in their life. That’s actually AZ 62.1. I.
A parent who is never there is AZ 62.0. So you can in a way give a person a really bad, or I won’t say a compliment, say something bad about them without them knowing it. But here’s an interesting, whenever you ever have a friend or family member that works in a hospital and they come home and can be like, oh my God, in the emergency room last night, this person came in, you’re not gonna believe what they put inside their body.
There are diagnosis codes for foreign bodies entering a natural orifice. These are all new ones. They’re in the W section. I want everyone to just give me a moment to think. We have a code that talks about you’re putting a battery or a button bat. So a decel or a button battery. A plastic object, A bead, a coin, a toy, jewelry.
And here’s what I find interesting. There’s bottles. But here’s the, I just find glass or sharp glass. And I guess there is a difference. There could be, nons, sharpp, glass. Here’s my point. Coding can be fun. You ever wanna say something bad about someone? There’s a way of coding it. What I’ll point out is there’s codes for everything.
So if you’re seeing something, trust me, there’s a way to code it. What I’m concerned about, is it something that is under acupuncture’s purview? Is it something we get paid for? And if it is, we wanna know it. The American Acupuncture Council, as I said, is your partner. The network is always here to help with that.
I hope to see you at a future seminar. Come January or at any time, become a member. Let me be part of your staff. Go out and do well. I’m wishing you the best. Code changes for this year. Don’t start in 2024. They started in October. Make sure you update your list, everyone. Until next time, take care.