If you’re a massage therapist who bills insurance (which in itself can be a daunting task), you’ve likely been following the code set transition from ICD-9 (International Classification of Diseases) to ICD-10 that began on Oct. 1, 2015.
For those who are new to insurance billing, ICD codes are defined by the World Health Organization as the standard diagnostic tool for epidemiology, health management and clinical purposes—including the analysis of the general health situation of population groups. These codes are used to monitor the incidence and prevalence of diseases and other health problems, which helps provide a more complete picture of the general health situation of countries and populations.
Put simply: These diagnostic codes are used by the client’s primary care provider when determining proper treatment and will appear on the client’s prescription.
Between ICD-9 and ICD-10 Codes ICD-10 codes are different from ICD-9 codes in several ways, but the most important difference is they are more specific than ICD-9 codes. In many cases, there is more than one ICD-10 code for the previous ICD-9 code. Generally, ICD-10 codes require a high level of specificity. For example, if a client has a shoulder injury, the ICD-10 codes require the health care provider to identify whether the injury was to the left or right shoulder.
Of course, massage therapists are not responsible for determining a medical diagnosis for their clients. Code selection is the responsibility of the health care provider who is legally accountable for establishing the patient’s diagnosis, usually a physician or a physician extender, such as a nurse practitioner. If a massage therapist has questions about the diagnosis a doctor selects, they must contact the doctor for clarification. Massage therapists should never change the code selected by the doctor.
Making a Claim
State licensing laws control whether massage therapists can bill health insurance for their services. Massage therapists should fully understand the scope of practice in their state to make sure they are billing health insurance only for services within the state scope of practice law. (Find more information about your state.)
Additionally, health insurance claims are legal documents, so massage therapists must collect and retain information supporting their requests for payments. Typically, a claim file must have documentation to confirm that the service was provided—at a minimum. Insurance companies also usually require a doctor’s order for a service before they will pay a claim, so make sure you are familiar with the requirements of the insurance companies they work with.
Not all of the codes listed fall within the scope of practice of massage therapy. Everyone within the health care community is getting comfortable with the new codes. This list can be used as a catalyst for discussion with the prescribing provider.
Keep in mind that these codes are updated periodically—adding, deleting and/or refining codes and descriptors. Staying up to date with new codes can help facilitate claims processing and reimbursement.
Download the full Massage Therapy Journal article—which includes the ICD-10 charts—to keep for quick reference.