Code of Conduct

New coding regulations: A major adjustment for chiropractors

What will the new ICD-10 codes mean for Ben’s practice?

“I’m a lucky man,” said Ben. His wife Carmen had brought an envelope full of family photos to his chiropractic office. The two of them had taken their son Jonathan for a photo shoot in a community park, but the pictures looked as though they had been taken in a pristine forest. “That photographer has skills.”

“True, but she also had some great material to work with,” Carmen teased him.

“We are a photogenic family,” Ben admitted with a wink. “I want the one with Jonathan on my shoulder for the office. We look so happy!”

“That’s because we are happy,” Carmen pointed out. “But you didn’t actually look very happy when I came in. I thought things were going well with the practice.”

“They are,” Ben assured her. “But now that I’m getting control over things in the practice and feeling happier at work, I’ve had time to notice an upcoming change in reporting requirements that feels a lot like… hmm… maybe a giant wave coming at me.”

Carmen took Ben’s hand. “A trouble shared is a trouble halved. Tell me about it.”

“Well, you know we use codes when we file insurance claims. By October 1, 2014, we have to change them all.”

“Sounds like some extra work for your staff, but not exactly like a huge wave about to crash over your head.”

“It’s kind of hard to know… We don’t know right now which codes for chiropractic will be identified as ‘medically necessary,’ for example, and we know that it won’t just be a question of renaming. We can’t just find all the 724.3 codes and change them to the single new code that will cover it. There are a lot more ICD-10 codes than ICD-9 codes, and there won’t be a one-to-one correspondence. We might need to make some judgement calls about what’s the best new code for a given procedure. If we make the wrong choice, we might not get reimbursed. And that’s just one thing. I don’t really know how many more things there are like that.”

“Okay, I can see that you’ll need to be involved in the change. But is it mostly just about learning the new codes?”

“I know that the new ICD-10 codes have seven digits instead of five, like the current ICD-9 codes. That could mean all new forms.” Ben frowned. “I guess I just don’t know what’s involved, to tell you the truth. But the government notices have said that it’ll affect scheduling as well as billing, and the way doctors make notes, and — well, pretty much everything we do.”

Carmen started putting the photos back into the envelope, leaving out the one Ben had chosen for his office. “It sounds like you don’t have enough information right now,” she said. “I’m not saying don’t worry — it does sound like something to worry about. But it doesn’t sound as though you know the size and shape of the problem yet. It’s like at the pizzeria–”

Ben laughed. “Everything reminds you of pizza!”

“Okay, that might be true. But when we know we have big parties coming in, that’s very different from just feeling like it’s going to be a busy night. When it comes to this reporting change, you basically don’t know how much pepperoni you need to have on hand.”

“Pepperoni sounds good. Let’s grab some lunch and I’ll worry about this stuff later.”

“Just don’t leave it too late — October will be here before you know it.”