Chiropractic Code Set Chiropractor (150) Effective July 2003 Last Updated July 1, 2014

Transcription

1 Chiropractic Code Set Chiropractor (150) Effective July 2003 Last Updated July 1, Tables 1 through 4 identify the procedure codes that should be billed to the Indiana Health Coverage Programs (IHCP) by chiropractors. 2. Tables 5 and 6 identify diagnosis codes appropriate for chiropractic services billed to the IHCP. 3. Principal diagnosis codes in Table 5 listed with an asterisk (*) are limited to medically necessary services rendered to Package B members effective July 1, Table 1 Covered IHCP Chiropractic for Office Visits Office or other outpatient visit for evaluation and management of new patient, problems are self-limited or minor Office or other outpatient visit for evaluation and management of new patient, presenting problems are of low or moderate severity Office or other outpatient visit for evaluation and management of new patient, presenting problems are of moderate severity Office or other outpatient visit for the evaluation and management of an established patient, presenting problem(s) are minimal Office or other outpatient visit for the evaluation and management of an established patient, presenting problem(s) are self-limited or minor Office or other outpatient visit for the evaluation and management of an established patient, presenting problem(s) are low to moderate severity Table 2 Covered IHCP Chiropractic for Manipulative Treatment Chiropractic manipulative treatment (CMT); spinal, one to two regions Chiropractic manipulative treatment (CMT); spinal, three to four regions Chiropractic manipulative treatment (CMT); spinal, five regions Chiropractic manipulative treatment (CMT); extraspinal, one or more regions Chiropractors may perform laboratory tests, which fall within their scope of practice for the State of Indiana (IC and Title 846, which include blood analysis and urinalysis). Table 3 Covered IHCP Chiropractic for Radiology Radiologic examination, spine, entire, survey study, anteroposterior and lateral Radiologic examination, spine, single view, specify level Radiologic examination, spine, cervical; two or three views Radiologic examination, spine, cervical; minimum of four views Complete, including oblique and flexion and /or extension studies Page 1 of 9 Last updated 07/01/2014

2 Table 3 Covered IHCP Chiropractic for Radiology Radiologic examination, spine, thoracolumbar, standing (scoliosis) Radiologic examination, spine, thoracic, two views Radiologic examination, spine, thoracic, three views Radiologic examination, spine, thoracic, complete, including obliques, minimum of four views Radiologic examination, spine, thoracolumbar, anteroposterior and lateral Radiologic examination, spine, scoliosis study, including supine and erect studies Radiologic examination, spine, lumbosacral, two or three views Radiologic examination, spine, lumbosacral, minimum of four views Radiologic examination, spine, lumbosacral, complete, including bending views Radiologic examination, spine, lumbosacral, bending views only, minimum of four views Radiologic examination, pelvis; one or two views Radiologic examination, pelvis; complete, minimum of three views Radiologic examination, sacroiliac joints; less than three views Radiologic examination, sacroiliac joints; three or more views Radiologic examination, sacrum and coccyx, minimum of two views Radiologic examination; clavicle, complete Radiologic examination; scapula, complete Radiologic examination, shoulder; one view Radiologic examination, shoulder; complete, minimum of two views Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Radiologic examination; humerus, minimum of two views Radiologic examination, elbow; two views Radiologic examination, elbow; complete, minimum of three views Radiologic examination; forearm, two views Radiologic examination, wrist; two views Radiologic examination, wrist; complete, minimum of three views Radiologic examination, hand; two views Radiologic examination, hand; minimum of three views Radiologic examination, finger or fingers, minimum of two views Radiologic examination, hip, unilateral; one view Radiologic examination, hip, complete; minimum of two views Radiologic examination, hip, bilateral, minimum of two views of each hip, including anteroposterior view of pelvis Radiologic examination, femur, two views Radiologic examination, knee; one or two views Radiologic examination, knee; three views Radiologic examination, knee; complete four or more views Radiologic examination, knee; both knees, standing, anteroposterior Radiologic examination; tibia and fibula, two views Radiologic examination, ankle, two views Radiologic examination, ankle; complete, minimum of three views Radiologic examination, foot; two views Page 2 of 9 Last updated 07/01/2014

3 Table 3 Covered IHCP Chiropractic for Radiology Radiologic examination, foot; complete, minimum of three views Radiologic examination; calcaneus, minimum of two views Radiologic examination, toe(s), minimum of two views Table 4 Covered IHCP Chiropractic for Medicine Services Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk Muscle testing, manual (separate procedure); hand with or without comparison with normal side Application of a modality to one or more areas; traction, mechanical Application of a modality to one or more areas; electrical stimulation (unattended) Application of a modality to one or more areas; vasopneumatic devices Application of a modality to one or more areas; paraffin bath Application of a modality to one or more areas; whirlpool Application of a modality to one or more areas; diathermy Application of a modality to one or more areas; infrared Application of a modality to one or more areas; ultraviolet Application of modality to one or more areas; electrical stimulation (manual), each 15 minutes Application of modality to one or more areas; iontophoresis, each 15 minutes Application of modality to one or more areas; contrast baths, each 15 minutes Application of modality to one or more areas; ultrasound, each 15 minutes Application of modality to one or more areas; Hubbard tank, each 15 minutes Application of a modality to one or more areas; unlisted modality (specify) Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular exercises Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Therapeutic procedure, one or more areas, each 15 minutes, gait training (includes stair climbing) Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) Therapeutic procedure, one or more areas, each 15 minutes; unlisted procedure (specify) Manual therapy techniques (e.g. mobilization/manipulation, manual lymphatic drainage, manual traction), one of more regions, each 15 minutes Page 3 of 9 Last updated 07/01/2014

4 Table 5 for Chiropractic Services Tension headache Spasmodic torticollis Cluster headache syndrome, unspecified Episodic cluster headache Chronic cluster headache Episodic paroxysmal hemicrania Chronic paroxysmal hemicrania Short lasting unilateral neuralgiform headache with conjunctival injection and tearing Other trigeminal autonomic cephalgias Tension type headache, unspecified Episodic tension type headache Chronic tension type headache Post-traumatic headache, unspecified Acute post-traumatic headache Chronic post-traumatic headache Other specified headache syndromes Classical migraine without mention of intractable migraine Classical migraine with intractable migraine, so stated Migraine with aura, without mention of intractable migraine, with status Migraine with aura, with intractable migraine, so stated, with status Common migraine without mention of intractable migraine Common migraine with intractable migraine, so stated Migraine without aura, without mention of intractable migraine with status Migraine without aura, with intractable migraine, so stated, with status Variants of migraine without mention of intractable migraine Variants of migraine with intractable migraine, so stated Variants of migraine, not elsewhere classified, without mention of intractable migraine with status Variants of migraine, not elsewhere classified, with intractable migraine, so stated, with status Hemiplegic migraine, without mention of intractable migraine without mention of status Hemiplegic migraine, with intractable migraine, so stated, without mention of status Hemiplegic migraine, without mention of intractable migraine with status Hemiplegic migraine, with intractable migraine, so stated, with status Menstrual migraine, without mention of intractable migraine without mention of status Menstrual migraine, with intractable migraine, so stated, without mention of status Page 4 of 9 Last updated 07/01/2014

5 Table 5 for Chiropractic Services Menstrual migraine, without mention of intractable migraine with status Menstrual migraine, with intractable migraine, so stated, with status Persistent migraine aura without cerebral infarction, without mention of intractable migraine without mention of status Persistent migraine aura without cerebral infarction, with intractable migraine, so stated, without mention of status Persistent migraine aura without cerebral infarction, without mention of intractable migraine with status Persistent migraine aura without cerebral infarction, with intractable migraine, so stated, with status Chronic migraine without aura, without mention of intractable migraine without mention of status Chronic migraine without aura, with intractable migraine, so stated, without mention of status Chronic migraine without aura, without mention of intractable migraine with status Chronic migraine without aura, with intractable migraine, so stated, with status Other forms of migraine without mention of intractable migraine Other forms of migraine with intractable migraine, so stated Other forms of migraine, without mention of intractable migraine with status Other forms of migraine, with intractable migraine, so stated, with status Migraine, unspecified, without mention of intractable migraine Migraine, unspecified, with intractable migraine, so stated Migraine, unspecified, without mention of intractable migraine with status Migraine, unspecified, with intractable migraine, so stated, with status Rachial plexus lesions Lumbosacral plexus lesions Cervical root lesions, not elsewhere classified Thoracic root lesions, not elsewhere classified Lumbosacral root lesions, not elsewhere classified Phantom limb (syndrome) Other nerve root and plexus disorders Unspecified nerve root and plexus disorder Causalgia of upper limb Other mononeuritis of upper limb Mononeuritis of upper limb, unspecified Causalgia of lower limb Other mononeuritis of lower limb Mononeuritis of lower limb, unspecified Unspecified complication of pregnancy, antepartum condition or complication Bone and joint disorders of the back, pelvis, and lower limbs, antepartum condition or complication Page 5 of 9 Last updated 07/01/2014

6 Table 5 for Chiropractic Services Other current conditions classifiable elsewhere, antepartum condition or complication Pain in joint, site unspecified Pain in joint, shoulder region Pain in joint, upper arm Pain in joint, forearm Pain in joint, hand Pain in joint, pelvic region and thigh Pain in joint, lower leg Pain in joint, ankle and foot Pain in joint, other specified site Pain in joint, multiple site Ankylosing spondylitis Spinal enthesopathy Cervical spondylosis without myelopathy Thoracic spondylosis without myelopathy Thoracic spondylosis without myelopathy Lumbosacral spondylosis without myelopathy Thoracic or lumbar spondylosis with myelopathy; thoracic region Thoracic or lumbar spondylosis with myelopathy; lumbar region Kissing spine Anklyosing vertebral hyperostosis Traumatic spondylopathy Spondylosis of unspecified site without mention of myelopathy Spondylosis of unspecified site; with myelopathy Displacement of cervical intervertebral disc without myelopathy Displacement of lumbar intervertebral disc without myelopathy Displacement of thoracic intervertebral disc without myelopathy Displacement of intervertebral disc, site unspecified, without myelopathy Schmorl s nodes, unspecified region Schmorl s nodes, thoracic region Schmorl s nodes, lumbar region Degeneration of cervical intervertebral disc Degeneration of thoracic or thoracolumbar intervertebral disc Degeneration of lumbar or lumbosacral intervertebral disc Degeneration if intervertebral disc, site unspecified Postlaminectomy syndrome, unspecified region Postlaminectomy syndrome, cervical region Postlaminectomy syndrome, thoracic region Postlaminectomy syndrome, lumbar region Other and unspecified disc disorder, unspecified region Other and unspecified disc disorder, cervical region Other and unspecified disc disorder, thoracic region Other and unspecified disc disorder, lumbar region Page 6 of 9 Last updated 07/01/2014

7 Table 5 for Chiropractic Services Spinal stenosis in cervical region Cervicalgia Cervicocranial syndrome Cervicobrachial syndrome (diffuse) Brachial neuritis or radiculitis NOS Torticollis, unspecified Other syndromes affecting cervical region Unspecified musculoskeletal disorders and symptoms referable to neck Spinal stenosis, unspecified region Spinal stenosis, thoracic region Spinal stenosis, lumbar region Spinal stenosis of other region Pain in thoracic spine Lumbago Sciatica Thoracic or lumbosacral neuritis or radiculitis, unspecified Backache, unspecified Disorders of sacrum Unspecified disorders of coccyx Other disorders of coccyx Other symptoms referable to back Other unspecified back disorders Plantar fascial fibromatosis Spasm of muscle Myalgia and myositis, unspecified Fascitis, unspecified Pain in limb Juvenile osteochondrosis of spine Adolescent postural kyphosis Kyphosis (acquired) (postural) Kyphosis (acquired) postlaminectomy Kyphosis (acquired) other Lordosis (acquired) (postural) Lordosis (acquired) postlaminectomy Lordosis (acquired) other postsurgical lordosis Lordosis (acquired), other Scoliosis [and kyphoscoliosis] idiopathic Resolving infantile idiopathic scoliosis Progressive infantile idiopathic scoliosis Thoracongenic scoliosis Kyphoscoliosis and scoliosis other Curvature of spine associated with other conditions curvature of spine, unspecified Curvature of spine associated with other conditions, kyphosis Curvature of spine associated with other conditions, lordosis Page 7 of 9 Last updated 07/01/2014

8 Table 5 for Chiropractic Services Curvature of spine associated with other conditions, scoliosis Other curvatures of spine Unspecified curvature of spine Acquired spondylolisthesis Nonallopathic lesions Head region Nonallopathic lesions Cervical region Nonallopathic lesions Thoracic region Nonallopathic lesions Lumbar region Nonallopathic lesions Sacral region Nonallopathic lesions Pelvic region Nonallopathic lesions Lower extremities Nonallopathic lesions Upper extremities Nonallopathic lesions Rib cage Congenital torticollis Certain congenital musculoskeletal deformities of spine Spondylolysis, lumbrosacral region Spondylolisthesis Headache Cervical vertebra dislocation, closed cervical vertebra, unspecified Cervical vertebra dislocation, closed first cervical vertebra Cervical vertebra dislocation, closed second cervical vertebra Cervical vertebra dislocation, closed third cervical vertebra Cervical vertebra dislocation, closed fourth cervical vertebra Cervical vertebra dislocation, closed fifth cervical vertebra Cervical vertebra dislocation, closed sixth cervical vertebra Cervical vertebra dislocation, closed seventh cervical vertebra Cervical vertebra dislocation, closed multiple cervical vertebra Lumbar vertebra dislocation, closed Thoracic vertebra dislocation, closed Sprains and strains of lumbosacral (joint) (ligament) Sprains and strains of sacroiliac ligament Sprains and strains of sacrospinatus (ligament) Sprains and strains of sacrotuberous (ligament) Sprains and strains of other specified sites of sacroiliac region Sprains and strains of unspecified site of sacroiliac region Sprains and strains of other and unspecified parts of back neck Sprains and strains of other and unspecified parts of back thoracic Sprains and strains of other and unspecified parts of back lumbar Sprains and strains of other and unspecified parts of back sacrum Sprains and strains of other and unspecified parts of back coccyx Sprains and strains of other and unspecified parts of back unspecified site of back Late effect of injury to nerve root(s), spinal plexus(es), and other nerves of trunk Injury to cervical nerve root Page 8 of 9 Last updated 07/01/2014

9 Table 5 for Chiropractic Services Injury to dorsal nerve root Injury to lumbar nerve root Injury to sacral nerve root Injury to brachial plexus Injury to lumbrosacral plexus Injury to nerve of pelvic girdle and lower limb sciatic nerve Injury to nerve of pelvic girdle and lower limb femoral nerve Injury to nerve of pelvic girdle and lower limb posterior tibial nerve Injury to nerve of pelvic girdle and lower limb peroneal nerve Injury to nerve of pelvic girdle and lower limb cutaneous sensory nerve, lower limb Injury to nerve of pelvic girdle and lower limb other specified nerve(s) of pelvic girdle and lower limb Injury to nerve of pelvic girdle and lower limb multiple nerves of pelvic girdle and lower limb Injury to nerve of pelvic girdle and lower limb unspecified nerve of pelvic girdle and lower limb Page 9 of 9 Last updated 07/01/2014