Are there updates to ICD10? I attempted to enter M79.1 for myalgia (muscle pain) and it was rejected by my clearing house as being invalid. What is the new code for myalgia?
Yes, indeed there has been and update to ICD10 CM coding. The 2019 changes for ICD10 take place October 1 of each year as they have since the inception of ICD10 (and for that matter same pattern was true when we used ICD9).
Changes for 2018-2019
This year is no different and there are changes that will likely affect the acupuncture provider. Some years like 2016-2017 there were significant changes and additions to cervical disc conditions, TMJ disorders, and neuralgia of the extremities which accounted for about 75 codes that are utilized by acupuncture professionals. However, the 2017-2018 changes were minor with only a slight update to lumbar spinal stenosis. Note the stenosis codes are a payable diagnosis for acupuncture with CIGNA and most Blue Cross Blue Shield plans as well as United Health Care.The updates for 2019 however though not as great in numbers as 2016-2017 are significant. Here is the summary of updates. There are now 71.932 distinct ICD10-CM codes for 2019. This represents an addition of 279 codes, 51 deletions, and 143 revisions.
The significant change for acupuncture professionals are the codes for myalgia. Myalgia, of course, is muscle pain and often referred to as myofascial pain syndrome. The most common etiology is likely chronic muscle tension, overuse or injury/trauma. The current code is M79.1 and that code is being deleted with that addition of four new codes with greater specificity. The new codes are:
- M79.10 - Myalgia, unspecified site
- M79.11 - Myalgia of mastication muscle
- M79.12 - Myalgia of auxiliary muscles, head, and neck
- M79.18 - Myalgia, other site
The most likely used in an acupuncture setting may be M79.12 which identifies muscle of the neck and head or M79.18 other site. Other site refers to a region that can be identified but is not the muscles of mastication nor muscles of the head and neck. M79.10 though a viable code is not likely used as unspecified refers to a region you cannot define or identify and clearly if you identify myalgia is will be in a region and in that sense any area other than muscles of mastication or auxiliary muscles of the head and neck would be M79.18 other site.
The Type 1 excludes (meaning codes that cannot be used together) for myalgia will remain fibromyalgia M79.7 and myositis codes M60 series. Simply put do not code either of those codes on the same claim as myalgia.
Other Updates
Also, of interest to an acupuncturist would be the updates to postpartum depression. In fact, now there will be a direct code for postpartum depression and not lumped into psychosis.
- F53 - Puerperal psychosis (deleted 10-1-2018)
- F53.0 - Postpartum depression
- F53.1 - Puerperal psychosis
While not common coding with many acupuncture professionals I am noticing a trend of coverage from some payers that do pay for anxiety/depression and this would fit into that category. Or at the very least be a complication or comorbidity factor.
The other changes likely may have little use from most acupuncture providers but these following updates may have some interest. The codes for muscular dystrophy updated also with greater specificity. The current code is G71.0 and that code is being deleted with the addition of four codes with greater specificity. The new codes are:
- G71.00 - Muscular dystrophy, unspecified
- G71.01 - Duchenne or Becker muscular dystrophy
- G71.02 - Facioscapulohumeral muscular dystrophy
- G71. 09 - Other specified muscular dystrophies
- H57.8 - Other specified disorders of eye and adnexa (deleted 10-1-2018)
- H57.811 - Brow ptosis, right
- H57.812 - Brow ptosis, left
- H57.813 - Brow ptosis, bilateral
- H57.819 - Brow ptosis, unspecified
- H57.89 - Other specified disorders of eye and adnexa
While not common these are conditions at the very least would be a complication or comorbidity of other conditions under care. Note, these changes occurred October 1, 2018, and the codes are based on the date of service. If the services were prior then use the current codes but all dates of service after must be the newer codes.
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