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Hey, greetings, my friends. This is Sam Collins, the coding and billing expert. And guess what? It’s October. What does it mean when it’s October? In fact, here’s a good riddle. What or when does the 2025 diagnosis begin? You’re thinking it’s 2025, Sam. Shouldn’t it begin in 2025? Actually, no, it began October 1st.
So do keep in mind that diagnosis codes do not update the year, but they update the October before. So the riddle is the 2024 diagnosis. or excuse me, the 2025 diagnosis, they update October 1st. And like with any year, I’m going to be very chiro specific. There could be other codes that may have update, but if it has no pertinence to what we do in the profession, I’m not really that focused.
So what I do is I focus on what’s changing that’s specific to the profession of chiropractic. And this is what you need to begin changing as soon as possible. As of now. So let’s go to the slides. Let’s talk about what has updated for 2025 for diagnosis codes. As I’m sure you’re aware, diagnosis codes are not stagnant.
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They always have a little bit of an update. Every year there’s going to be some types of revisions or updates. Not every code. So you’ll see here there’s 74, 000. Diagnosis codes. 74, 260. Are we ever going to use that many? Of course not. In fact, most chiros probably use like the same 20 or 30 codes pretty commonly because we see the same things.
But it’s important to know when codes do update. Like by example, remember when the diagnosis codes for back pain changed? This year is no different. There’s been, I think, a significant update you definitely want to be aware of and you want to make sure that you’re using the codes properly. With these codes, let’s keep in mind, if the date of service was September 30th or earlier, you will continue using the older code.
If the date of service is after October 1st, then you use the new code. So I had someone last week that updated them too quickly, and of course it got denied because it’s about the date of service. So keep in mind, if you’re treating someone in September, but you’re not sending the bill until late October or November, you’re still going to use the old code.
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So keep in mind, the date of billing does not affect the code. The date of service. So make sure that you use the codes based on the date of service. Which means, a patient you were seeing in September, you’re going to use the old code. Once you start seeing them in October, then you’re going to update to the new code.
What has changed or updated? We’ve had a significant change in Lumbar Disc. I like this, I think this makes a lot of sense. Instead of having just the plain code for other intervertebral disc degeneration lumbar, meaning disc degeneration of lumbar spine, we’re now differentiating it into a little bit more information, more granular.
I like this because you’re going to see here, this is going to allow you to start to put in a little bit more specifics or specificity to severity. So the new codes are going to be M51360, which is the disc degeneration lumbar, but with discogenic back pain. In other words, there’s back pain associated with the disc.
I think you’re thinking of course, Sam, that may be the case. But realize that’s what they’re focusing on is that now they’re differentiating because there’s one for back pain. But what about the patient that comes in and has disc degeneration, but only has pain in the leg? So lower extremity pain, then it’s going to be M51 361.
So you can see here, it’s a lot, a little more specificity. Is it only pain in the back? Or is it only pain in the leg? Or there’s another choice, M51362, which is disc degeneration with back pain and lower extremity pain. So when there’s both. So the idea now is specificity to back pain, extremity pain, or both.
But in fact, keep in mind, there could be one more. If you’ve ever had a person that has disc degeneration, you do x rays or possibly an MRI, and it’s showing significant degeneration, but they actually have no pain. There are a lot of people like that. Obviously, I think everyone experiences some degeneration.
It’s not to the point where it causes some pressure on a nerve or a joint capsule that it begins to hurt. So now there’s one without any mention of it. So in other words, you have an incidental finding on a x ray. It’s still significant. I think a person with degeneration. regardless of experiencing pain is still going to have the same issue.
So keep in mind, we want to make sure that when you’re using these codes now, we have a code for lumbar disc that is specific to lumbar disc degeneration, whether it’s pain in the back, pain in the leg, or pain in both, or without any mention of pain at all. We also have updated for lumbosacral disc.
So lumbosacral disc, you’ll see currently we have M51 37. And now what we’re saying with degeneration, we’re going to say, Oh, it’s the same thing. We have one for back pain. One for extremity pain and then one for discogenic back pain or lower extremity pain. So it’s Oh, okay. So we have one for back pain, leg pain, or both.
Now, some will say does this replace sciatica? Not necessarily, but it’s certainly if the disc is causing that, then of course, we will set it here. Not saying specifically sciatica. Then of course, there’s that one without any mention of it whatsoever. Now, one thing to keep in mind is that these codes, again, October 1st.
So data service after use the new codes. But here’s something you want to be careful of. Never code spinal pain codes with any disc codes. This is one area I’ve run into lots of offices with denials, particularly recently. Please keep in mind that if you have any type of back pain code, and I don’t care if this is cervical thoracic lumbar, do not include a back pain code.
with any disc code other than the new one that says M51 360, which of course is the back pane. Otherwise, a back pane code in M54 series will automatically deny. So as a rule, what I’d like you all thinking of is when you are using back pane and disc, drop the back pane code. Give me the disc code. Keep in mind also lower back pane unspecified has updated.
Remember this is a while ago. M54 50, 51. Keep in mind, none of these you should use. None of these you should use with discodes. And keep in mind, one thing that comes up, Medicare Part B’s and C’s seem to like better. M 54 51 or the M 54 59. So what’s changed? Lumbar disc. Now you might think Sam, did they change the ones for cervical or for thoracic?
They did not. Only the low back code. So if you’re gonna update your code list, make sure you go through, strike out the M 51, 36, and 37, and then add these new codes to it. In addition though, there’s been some updated codes as well for. TanoSinovitis or Sinovitis in the extremities. And all this does is really just add more specificity.
You’ll notice we have a code that says Sinovitis, TanoSinovitis, just unspecified. It’s where is it? So what they’ve done now is added, oh, let’s talk about it. Instead of just having one code for unspecified, we can now say, oh, is it in the shoulder? In the arm, in the forearm, in the hand, okay? Or in the thigh, in the lower leg.
In other words, it’s more specificity for the region where you’re having the pain. So when someone says to you, Hey, the diagnosis codes update, they’re right. Those codes did update. Is this a major change? I think when it comes to lumbar disc degeneration and synovitis tenosynovitis, it certainly does.
Please make sure you’ve updated your list to add these codes to it to make sure you don’t use the wrong code. Because if you put in a code that’s incorrect, the claim will simply come back as non payable because of an invalid diagnosis. And you’re gonna be thinking, what do you mean? Because you’re not using the updated code.
So again, keep in mind These codes change for October 1st. Dates of service. If the date of service was before October 1st, please make sure you’re using the old code. Now there is one more code that was added, and this one’s not going to pop up on screen, but the code is M62 85, and that’s dysfunction of the multifidus muscles.
Now I don’t put that one up because I don’t think that’s a common code we use, but I do want to highlight when a person has muscle issues associated with their back, It would be good to put it in either as a complicating or comorbidity. So that’s the diagnosis updates for this year. So for 2025, you have the new codes specifically chiropractic, tenosynovitis, synovitis and lumbar or lumbosacral disc codes.
Otherwise I’ll say to you all my friends, Until next time, always stay on top. In fact, ChiroSecure and H. J. Ross is there for you. If you’re needing some help, realize, reach out to me. I’m the person that always helps. Go to our website, hjrosscompany. com. Click on the network. Take a look, see what it takes to be a member and let’s start working together.
Take care of my friends.
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