M51.371 Other intervertebral disc degeneration, lumbosacral region with lower extremity pain only


Other intervertebral disc degeneration, lumbosacral region with leg pain only


Other intervertebral disc degeneration, lumbosacral region with referred sclerotomal pain only


M51.372 Other intervertebral disc degeneration, lumbosacral region with discogenic back pain and lower extremity pain


Other intervertebral disc degeneration, lumbosacral region with discogenic back pain and leg pain


Other intervertebral disc degeneration, lumbosacral region with axial back pain and referred sclerotomal pain


M51.379 Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or lower extremity pain


Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or leg pain


Other intervertebral disc degeneration, lumbosacral region, NOS


Keep in mind that, as of Oct. 1, 2024, M51.36 or M51.37 are no longer valid codes. A sixth character is required.


Claims with


these old codes will be denied. Be sure to update your billing software to reflect this change.


One advantage of this change may be that, as a primary diagnosis, this additional detail can help to better establish medical necessity without the need for a review of the records. In your records, be sure to indicate the presence or absence of lumbar back pain and/or lower extremity pain. If you report one of the codes with the sixth character, “9”, meaning you chose not to document those details, expect an uphill battle. Or better yet, avoid the use of that sixth character. It means that you don’t have very detailed records.


 


The updated code set for 2025 includes the addition of the anatomic location in the upper or lower extremities for M65.9 Synovitis and tenosynovitis, unspecified. This code now requires a fifth character, which indicates shoulder (1), upper arm (2), forearm (3), hand (4), thigh (5), lower leg (6), ankle and foot (7), other site (8), and multiple sites (9). These codes also require a sixth character: right (1), and left (2).


The code will only be valid with six characters, whereas it had four characters previously.


Furthermore, each of these have the option of “9” for the sixth character to indicate that the documentation does not include which extremity is involved. For obvious reasons, avoid reporting this code with the “9” as the sixth character.


It implies that


the provider record is unnecessarily vague about the location of the condition.


 


Chapter 21 includes codes that start with “Z” and they represent reasons for encounters and factors influencing health status. They can be used to report detail on the claim form that reduces the need for payers to request records. In chiropractic, they might be added to a diagnosis code for a musculoskeletal condition, as an optional clarification.


Z59.7 Insufficient social insurance and welfare support was expanded to include a fifth character. The options are as follows:


Z59.71 Insufficient health insurance coverage Inadequate social insurance Insufficient social insurance No health insurance coverage


Z59.72 Insufficient welfare support Inadequate welfare support


Keep in mind that there are many other Z codes that include other details that may be helpful to report along with a condition. These are just some of the new ones for 2025.


There were many other changes to the code set for 2025, but these are the ones most likely to be relevant to chiropractors and physical medicine providers. To see the complete list of changes, go to CMS.gov.


—Dr. Gwilliam is the Senior Vice President of Practisync, which helps practices improve efficiency and collect more through outsourced expert billing services. As a member of your state association you can qualify for special rates. If you would like to see if Practisync could be a good fit, reach out to Dr. Gwilliam at evan.gwilliam@practisync.com or visit the website for more details.


Ple x u s Oct/Nov 20 2 4


19


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32