by Wyn Staheli, Director of Content - innoviHealth
Oct 3rd, 2023
It’s that time of year again, the ICD-10-CM codes for fiscal year 2024 are out so it’s time to take a look at these changes. Of all the hundreds of changes, the following could be of interest to doctors of chiropractic and are deleted and expanded as of October 1, 2023:
| E20.8 | Other hypoparathyroidism |
| G20 | Parkinson's disease |
| Q75.0 | Craniosynostosis |
| Z91.A4 | Caregiver's other noncompliance with patient's medication regimen |
| Z91.A9 | Caregiver's noncomliance with patient's other medical treatment and regimen |
In case you missed it, the following subcategories were expanded back on April 1, 2023:
| Z59.1 | Inadequate housing |
| Z91.14 | Patient's other noncompliance with medication regimen |
This article discusses some of these changes. Please note that there were also other changes that are not included in this article such as the addition of inclusion terms on some of the codes included in the 2024 ICD-10-CM Coding for Chiropractic book.
Chronic Migraine Expansion
Category G43- “Migraine” has been expanded to include a new subcategory (G43.E-) for chronic migraine with aura. These new codes are included in the 2024 ICD-10-CM Coding for Chiropractic and 2024 ChiroCode DeskBook. Keep in mind that at the time of publication, payer policies have not yet been updated, but in light of the fact that subcategory G43.7- “Chronic migraine without aura” is not included as covered on some payer policies, this one might also not be covered for chiropractic care. Watch for payer policy updates.
Hypoparathyroidism Changes for 2024
Hypoparathyroidism is characterized by insufficient levels of parathyroid hormone (PTH) which is produced by the parathyroid glands (small glands located in the neck near the thyroid gland). Low levels of PTH can lead to imbalances in calcium and phosphate levels which can lead to various symptoms such as:
- Muscle cramps and spasms
- Tingling or numbness in the hands, feet, or around the mouth
- Fatigue
- Mood swings or anxiety
- Cognitive disturbances
- Seizures (in severe cases)
Code E20.8 “Other hypoparathyroidism” was expanded primarily at the request for better tracking of autosomal dominant hypocalcemia (ADH). Now, specific types of hypoparathyroidism including ADH, secondary, and autoimmune can be tracked independently instead of using the single “other” code. Even though these codes are not likely to be commonly used within a chiropractic setting, it is important to understand that abnormal calcium and phosphate levels can affect gait, and therefore have the potential to affect musculoskeletal function.
According to the Parkinson’s Foundation, “Dyskinesias are involuntary, erratic, writhing movements of the face, arms, legs or trunk. They are often fluid and dance-like, but they may also cause rapid jerking or slow and extended muscle spasms. They are not a symptom of Parkinson's disease (PD) itself.” Whereas, Parkinson’s symptoms are different and include tremor, slowness, and stiffness. For this reason, new codes have been added to identify when these additional conditions occur in conjunction with Parkinson’s.
Coding for this condition has changed to report when it occurs with or without dyskinesia as well as identifying whether or not the patient is experiencing motor fluctuations (referred to as “on-off” times) describing changes in the patient’s ability to move. The following table shows the new codes:
| w/o dyskinesia | with dyskinesia | |
| w/o mention of fluctuations | G20.A1 | G20.B1 |
| with fluctuations | G20.A2 | G20.B2 |
Report the new unspecified code G20.C when there is no documentation of any of the above.
Craniosynostosis Coding Changes for 2024
Code Q75.0 “Craniosynostosis” has been expanded to identify different types of this condition as well as the addition of laterality for some codes, as applicable (e.g., Sagittal and metopic craniosynostosis are midline, therefore the side is not applicable). The American Society of Pediatric Neurosurgeons and the American Society of Craniofacial Surgeons requested this change stating that:
| Classification of the type of the craniosynostosis is essential for several reasons, including (1) to accurately measure and assess worldwide trends in the epidemiology of craniosynostosis types, (2) outcomes and treatments vary by craniosynostosis type and (3) the removal of antiquated terms (acrocephaly, oxycephaly) in the tabular, but will remain indexed.
Definitive diagnosis of craniosynostosis is typically made with radiographic imaging of the skull (e.g., computerized tomography) and physical examination performed by a craniosynostosis clinical expert (e.g., neurosurgeon, plastic surgeon). |
Based on that statement, it seems that this condition will not commonly be encountered in a chiropractic setting; however, some of the unspecified codes are included in the 2024 ICD-10-CM Coding for Chiropractic publication. Go to FindACode.com for a complete listing of all these codes.
Inadequate Housing Changes
With the increased emphasis on tracking social determinants of health (SDOH), there were requests to expand the options for inadequate housing (Z59.1). For example, knowing that a patient doesn’t have utilities (Z59.12) would be important to know when caring for a diabetic patient because they have a need to keep their insulin refrigerated. However, this is not something that would typically be of much clinical significance for chiropractic care.
It should also be noted that there have been some changes as well to the ICD-10-CM Official Guidelines for Coding and Reporting in relation to SDOH reporting. The first few paragraphs of Section 1;C.21.c.17 were changed in both April and October and have been included in the paragraphs that follow. New information is in bold type and removed information is in strikeout:
| Social determinants of health (SDOH) codes describing social problems, conditions, or risk factors that influence a patient’s health should be assigned when this information is documented in the patient’s medical record. Assign as many SDOH codes as are necessary to describe all of the social problems, conditions, or risk factors documented during the current episode of care. For example, a patient who lives alone may suffer an acute injury temporarily impacting their ability to perform routine activities of daily living.
When documented as such, this would support assignment of code Z60.2, Problems related to living alone. However, merely living alone, without documentation of a risk or unmet need for assistance at home, would not support assignment of code Z60.2. Documentation by a clinician (or patient-reported information that is signed off by a clinician) that the patient expressed concerns with access and availability of food would support assignment of code Z59.41, Food insecurity. Similarly, medical record documentation indicating the patient is homeless would support assignment of a code from subcategory Z59.0-, Homelessness. … |
Patient/Caregiver NonCompliance Changes
Noncompliance codes can be helpful when documenting reasons why a patient may not be progressing as anticipated. For example, they may skip appointments because they simply can’t pay for the visit. There were several requests to add a “financial hardship” option to the noncompliance codes (Z91.14-, Z91.A4-, Z91.A9-).
Addition of Pelvis to the Age-Related Osteoporosis with Current Pathological Fracture (M80.0-) Subcategory
Although this is not something that would be commonly encountered in a chiropractic setting, It is interesting to note that a new subcategory for “Age-related osteoporosis with current pathological fracture, pelvis” (M80.0B-) was created. The requestor for the code stated that “Autologous bone graft is used in a variety of orthopedic and maxillofacial procedures. The iliac crest of the pelvis is the most common site of autologous bone graft harvesting. In patients with osteoporosis, pathological fracture of the iliac crest can occur, either during or after the bone graft harvesting.” They previously had to use the “femur” code which was anatomically incorrect so they requested codes specifically for the pelvis.
Navigating the changes that affect your practice is important. Order your updated books today and stay current.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.
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