ICD 10 codes for neck pain
Physical therapists routinely treat neck pain and typically use the ICD-10 code for neck pain. 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. 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.
An introduction to low back pain ICD 10 codes
All HIPAA-covered entities are required to submit ICD-10 codes if seeking reimbursement for services from an insurance company. This includes physical therapists.
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).
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.
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.
Neck pain (Cervical GIA) ICD-10: 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.
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 it 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.
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.
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:
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
Additional ICD 10 code for neck pain considerations
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.
Neck pain ICD-10 codes can be hard. TheraPlatform can make it easier with its searchable ICD-10 database. They also offer practice management and EHR solutions for your private practice. They have a free 30-day trial with no credit card required. Cancel anytime.
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