ICD 10 codes for neck pain
ICD-10 code for neck pain is used by physical therapists for billing purposes. While it’s not the most common musculoskeletal condition, neck pain does affect many people and can result in significant financial burden related to treatment costs and days of lost work.
Summary
- The ICD-10 code for general neck pain is M54.2 (Cervicalgia), and it is typically used when a patient presents with acute or chronic discomfort in the cervical spine region. This code is billable, but it’s important to use the most specific code available to increase the chances of reimbursement. Enrolling in an insurance billing course for therapists can help providers enhance their knowledge.
- Physical therapists must understand how to use ICD-10 codes correctly, as they are required for insurance reimbursement and justify the medical necessity of treatment. Codes with more characters provide greater specificity and should align with the patient’s clinical presentation.
- Alternative ICD-10 codes may be more appropriate depending on the underlying cause of neck pain. These include codes for cervical disc disorders, spinal stenosis, and spondylosis. Using these specific codes can improve accuracy and billing outcomes.
- Using integrated EHR and billing software like TheraPlatform helps streamline insurance claim processes through automation, batching, and real-time claim validation. This reduces manual entry, minimizes errors, and saves therapists valuable administrative time.
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A survey completed in 2017 found that 3,551.1 out of every 100,000 people were experiencing neck pain. This suggests that finding effective treatment and prevention strategies for neck pain is of considerable importance.
Symptoms of neck pain can vary from person to person but may include the following:
- Dull, achy, sharp, or burning pain in the cervical spine
- Pain that radiates into the upper back, shoulders, arms, forearms or hands
- Pain that radiates into the occiput or skull
- Numbness or tingling in the arms, forearms or hands
- Pain or stiffness with neck movements
Because of its prevalence, you will likely encounter this condition frequently in your practice and understanding how to correctly utilize the ICD 10 code for neck pain is imperative for minimizing insurance claim denials. If you, like many therapists, have some experience searching for and selecting ICD 10 code for neck pain but don’t have a good understanding of the who, what, when and why these codes are used, see the next section for an ICD-10 code primer. Following this introduction we will discuss the neck pain ICD10 code in more detail.
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An introduction to ICD codes for physical therapists
Before jumping into the details on ICD 10 for neck pain, let’s refresh very quickly on the basics of what ICD 10 codes are and why physical therapists need them.
Who: All HIPAA-covered entities are required to submit ICD-10 codes if seeking reimbursement for services from an insurance company. This includes physical therapists.
What: The International Classification of Disease, 10th Revision (ICD-10) is a set of diagnosis, symptom, and procedure codes that physical therapists use daily in their practice. In 2015 physical therapists and all other HIPAA-covered healthcare providers transitioned from the ICD-9 to the current version, ICD-10. ICD-10 codes are alphanumeric codes. They begin with a letter and are always between three and seven characters with a decimal point placed after the third character.
The more characters it has, the more specific it is. Each code follows the following structure:
- Characters 1-3 indicate the category of the diagnosis
- Characters 4-6 indicate etiology, anatomic site, severity or other clinical detail
- Character 7 is an extension value, for example:
- A: Initial encounter (anything related to care of the initial injury)
- D: Subsequent encounter (anything related to the phase of routine care of the injury while the patient recovers–this usually refers to rehabilitation)
- S: Sequela (other conditions that may result from the presence of the primary condition)
Note, for fracture care, there are several more extensions (Example: P, G, K, which signify malunion, delayed healing, or nonunion for a subsequent encounter)
When: ICD-10 codes must be submitted with relevant documentation whenever reimbursement is sought for covered services either by the healthcare entity itself or by a patient.
Why: While it may seem like an extra step in an already detailed process of documentation and billing, ICD-10 codes are required for a specific reason. Not only do they identify a medical diagnosis, but perhaps more importantly, they help insurance companies understand why the care you are providing is medically necessary and therefore, reimbursable.
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What is the ICD code for neck pain?
Neck pain (Cervical GIA) ICD-10 code: M54.2
When selecting an ICD 10 code for neck pain, the code with the highest number of applicable characters should be chosen, at least on the first visit. Greater specificity is more likely to lead to reimbursement but it should always be supported by the patient’s medical record and clinical knowledge of the patient’s condition. Many three- and even sometimes four-digit codes can be found for a given condition when searching a reputable database like ICD10 Data, but if a more detailed code is available, this code may not be reimbursable by insurance.
M54.2: Cervicalgia
This ICD 10 code for neck pain is used in situations where the patient is presenting with discomfort or pain most often in the posterior or lateral cervical spine region lasting more than 3 months (chronic) or less than 3 months (acute).
Is the ICD 10 code for neck pain billable?
This ICD 10 code for neck pain is considered specific enough for billing/reimbursement purposes but alternative codes may be available that more accurately describe your patient’s condition.
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When is an alternative ICD 10 code for neck pain more appropriate?
Disorders of the intervertebral disc in the cervical spine is an example of a specific condition that may cause neck pain. If your patient has a cervical spine disc disorder, consider using one of these codes. The ICD 10 codes for neck pain listed here are too nonspecific for billing but you can find more specific codes by following the links.
Code | Condition |
|---|---|
Cervical disc disorder with myelopathy | |
Cervical disc disorder with myelopathy, mid-cervical region | |
Cervical disc disorder with radiculopathy | |
Other cervical disc displacement | |
Other cervical disc degeneration | |
Other cervical disc disorders | |
Cervical disc disorder, unspecified |
Aside from disc disorders, these are additional codes you may consider using in the case of neck pain:
Code | Condition |
Spinal Stenosis, cervical region | |
Other spondylosis with myelopathy, cervical region | |
Other spondylosis with myelopathy, cervicothoracic region | |
Other spondylosis with radiculopathy, cervical region | |
Other spondylosis with radiculopathy, cervicothoracic region | |
Spondylosis without myelopathy or radiculopathy, cervical region | |
Spondylosis without myelopathy or radiculopathy, cervicothoracic region | |
Injury of muscle, fascia and tendon at neck level–click to select more specific/billable version of this code |
ICD 10 code for neck pain tips
As you can see, even a case of simple neck pain can present a host of choices for ICD 10 codes.
When selecting an ICD 10 code for neck pain, here are some additional considerations to help with successful reimbursement:
- “Non specific” or “other” code: Whenever possible avoid using these codes as the primary diagnosis code if a more detailed and specific code is available
- Place of occurrence codes (Y92): Place of occurrence codes may be used during the initial evaluation to increase specificity of the primary diagnosis
- Examples 1: neck pain after working in the yard
- Y92.017 Garden or yard in single-family (private) house as the place of occurrence of the external cause
- External cause codes (V00-Y99): specify an external cause resulting in the episode of neck pain and may be used during the initial evaluation to increase specificity of the primary diagnosis
- Example 1: Car accident
- V43 Car occupant injured in collision with car, pick-up truck or van
Stay up to date: The Centers for Medicare and Medicaid Services publish an updated list of codes each year to go into effect October 1 and remain in effect until September 30 of the following year. Sites like ICD10 Data can also be helpful in identifying code changes once they update their list as announced on their homepage.
How EHR and practice management software can save you time with insurance billing for therapists
EHR with integrated billing software and a clearing house, such as TheraPlatform, offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
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Resources
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