2025 ICD-10-CM Code Updates: What Massachusetts Chiropractors Need to Know
Effective Date: October 1, 2024
The 2025 ICD-10-CM diagnosis code updates bring important changes that will impact chiropractic care in Massachusetts. These updates introduce 252 new codes, 36 deletions, and 13 revisions, reflecting evolving practices in healthcare documentation. Among these changes are new codes relevant to conditions frequently managed by chiropractors, such as lumbar disc degeneration, and revisions to synovitis and tenosynovitis codes.
It’s essential for chiropractors in Massachusetts to stay informed about these updates to ensure accurate documentation, compliance, and optimal reimbursement.
CMS Updates to Chiropractic Coverage
The Centers for Medicare & Medicaid Services (CMS) has revised the list of diagnostic codes that are considered medically necessary for chiropractic services. These changes apply to Medicare Part B and many Medicare Advantage (Part C) plans. Chiropractors should be aware that commercial insurers may use different coding systems, so verifying specific payer requirements is recommended.
The updated codes can be found in the Local Coverage Article (LCA) for Billing and Coding of Chiropractic Services on the CMS website.
New Codes for Lumbar and Lumbosacral Disc Degeneration (M51.36 & M51.37)
Several new codes allow chiropractors to document lumbar and lumbosacral conditions with greater precision. These updates will help ensure more accurate representation of patients’ symptoms and treatment needs.
New Codes for Lumbar Region
- M51.360 – Lumbar region with discogenic back pain only
- M51.361 – Lumbar region with lower extremity pain only
- M51.362 – Lumbar region with discogenic back pain and lower extremity pain
- M51.369 – Lumbar region without mention of lumbar back pain or lower extremity pain
New Codes for Lumbosacral Region
- M51.370 – Lumbosacral region with discogenic back pain only
- M51.371 – Lumbosacral region with lower extremity pain only
- M51.372 – Lumbosacral region with discogenic back pain and lower extremity pain
- M51.379 – Lumbosacral region without mention of lumbar back pain or lower extremity pain
These codes provide enhanced clarity when documenting specific back conditions, which may improve claim approvals and reimbursement.
Revised Codes for Synovitis and Tenosynovitis (M65)
The M65.9 (Synovitis and tenosynovitis, unspecified) category has been expanded to allow for more precise documentation. New sixth-character designations specify the affected extremity and laterality (left, right, or unspecified).
New Code Structure for Synovitis and Tenosynovitis (M65.9):
- M65.90 – Unspecified synovitis and tenosynovitis, unspecified site
- M65.91 – Unspecified synovitis and tenosynovitis, shoulder
- M65.911 – Right shoulder
- M65.912 – Left shoulder
- M65.92 – Unspecified synovitis and tenosynovitis, upper arm
- M65.921 – Right upper arm
- M65.922 – Left upper arm
- M65.93 – Unspecified synovitis and tenosynovitis, forearm
- M65.931 – Right forearm
- M65.932 – Left forearm
- M65.94 – Unspecified synovitis and tenosynovitis, hand
- M65.941 – Right hand
- M65.942 – Left hand
- M65.95 – Unspecified synovitis and tenosynovitis, thigh
- M65.951 – Right thigh
- M65.952 – Left thigh
- M65.96 – Unspecified synovitis and tenosynovitis, lower leg
- M65.961 – Right lower leg
- M65.962 – Left lower leg
- M65.97 – Unspecified synovitis and tenosynovitis, ankle and foot
- M65.971 – Right ankle and foot
- M65.972 – Left ankle and foot
- M65.98 – Unspecified synovitis and tenosynovitis, other site
- M65.99 – Unspecified synovitis and tenosynovitis, multiple sites
These updates will allow Massachusetts chiropractors to document patient conditions with greater specificity, enhancing communication with other healthcare providers and payers.
Key Takeaways for Massachusetts Chiropractors
- Effective Date: The new codes go into effect on October 1, 2024.
- Action Required: Ensure your documentation reflects the updated codes for lumbar disc degeneration and synovitis/tenosynovitis to avoid claim rejections.
- Resources: Review the CMS Local Coverage Article (LCA) to stay up-to-date on which codes are considered medically necessary for chiropractic services under Medicare.
- Commercial Insurers: Be aware that private insurers may have different coding guidelines, so check payer policies regularly.
By staying informed about these ICD-10-CM updates, Massachusetts chiropractors can ensure accurate billing, improve patient care, and streamline reimbursement processes.
Resources
For more information, visit the Centers for Medicare & Medicaid Services (CMS) website and review the 2025 ICD-10-CM updates
