This article discusses the upcoming updates to the ICD-10 manual, particularly focusing on the changes to the M54.5 code for low back pain (LBP). Effective October 1st, therapists who continue using M54.5 in their documentation and billing risk facing denials for reimbursement. The article explains the replacement of the M54.5 code with more specific options, such as M54.50, M54.51, and M54.59. It highlights the importance of updating patient records to ensure compliance and avoid claim rejections from Medicare, Medicaid, and private insurance providers. Additionally, the article offers advice on handling potential delays from insurance payers during the transition
According to the Centers for Medicare & Medicaid Services (CMS), there will be an update to the ICD-10 manual, likely affecting many therapists.
Every October, there are changes made to the ICD-10 manual, which include replacement, removal, and addition of codes. The change this October 1st will affect a common code used by many rehab professionals – low back pain (M54.5). This means that if you are using M54.5 on your documentation and billing on or after October 1, you risk getting denied reimbursement.
How HelloNote Helps You Stay Compliant
To maintain compliance with the updated codes, HelloNote’s built-in ICD-10 management system ensures that any existing or new patients have the correct and updated version of this code. HelloNote automatically updates codes such as M54.50 (Low back pain, unspecified), M54.51 (Vertebrogenic low back pain), and M54.59 (Other low back pain), preventing coding errors that could lead to claim denials.
Impact of ICD-10 Code Changes
Beginning October 1, stop using the outdated ICD-10 code for low back pain (M54.5). It will be replaced with more specific codes that reflect different types of low back pain. For some payers, it may take time to update their databases, so even though you bill with the new codes, you might still face denials or delays in claims processing.
M54.50 (Low back pain, unspecified)
M54.51 (Vertebrogenic low back pain)
M54.59 (Other low back pain)
How HelloNote Supports Billing and Reimbursement
With HelloNote’s integrated ICD-10 code tracking and validation system, you can easily revise codes to ensure your documentation aligns with medical necessity. The system automatically updates patient records with the latest codes, reducing the risk of denials. If an issue arises, HelloNote helps you quickly make corrections, and the re-submission process is streamlined.
What to Do to Avoid Denials
Please review your documentation to ensure the updated ICD-10 codes are applied as necessary. HelloNote’s automatic code updates will help you stay ahead, but it’s always a good idea to double-check your billing entries. If there is any delay in your payer’s database updates, HelloNote supports the resubmission process, making appeals and corrections as easy as possible.
Stay Updated with HelloNote
For a full list of ICD-10 code changes, you can visit the CMS website: https://www.cms.gov/medicare/icd-10/2022-icd-10-cm. HelloNote also ensures that your practice stays up-to-date with ongoing ICD-10 revisions, so you don’t miss any important updates.