ACA Statement on Subluxation ICD-10 Coding

The World Health Organization, which developed ICD-10, describes subluxation as, “a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity which may influence biomechanical and neural integrity.” With this definition in mind, the General Equivalence Mappings from CMS for ICD-10-CM  provide a  direct one to one match from the ICD-9  non-allopathic lesions codes (739 series) to ICD-10 as  Biomechanical lesions (M99 series).

Based on Medicare guidelines, the most appropriate code choice for a primary code would be the M99.0 code category;Segmental and somatic dysfunction.  The qualifying diagnostic codes ( also referred to as secondary codes), will also be a simple transition to the equivalent corresponding code set that best describes the patient’s condition.  ACA is opposed to any exclusions of diagnosis codes or restricted access to reporting conditions that fall within their scope of practice and meet the guidelines for reporting and documenting.

ACA is currently working with CMS to standardize the code requirements. In the meantime, we ask that you consult and code according to the guidelines provided by your MAC’s  Local Coverage Determination (LCD).

ACA has developed numerous tools and resources, specifically with the chiropractic profession in mind, to assist with proper transition and implementation of ICD-10 coding. Please visit www.acatoday.org/ICD10 for further information.

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