International Statistical Classification of Diseases and Related Health Problems codes or ICD-10 codes are created by the World Health Organization and are used around the world. They are diagnosis codes that are used when doctors prescribe massage so you will need to be up on what is going on. If you are billing insurance or taking some HSA/FSA plans, you will need to get the ICD-10 code from the prescribing physician. I am providing this information on codes to help you understand the codes. It is out of the scope of practice to used these codes without having a prescription from a physician that is using the codes. You are NOT able to just use a pain code without having a prescription from a doctor. Doctors need to rule out other things first.
The next version – ICD-11 are already on the way. In May 2019, ICD-11 will be presented at the Seventy-second World Health Assembly for endorsement by Member States. In January 2022, Following endorsement, Member States will begin reporting health data using ICD-11.
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ICD-9-CM codes were 5 digits
- First digit is alpha (E or V) or numeric
- Digits 2-5 are numeric
- Decimal is placed after the third character
- 14,000 codes
ICD-10-CM codes are 7 digits and there are 69,000 codes to better capture specificity.
- Digit 1 is alpha.The two main category of codes massage therapists will see most of are the M and S codes:
- M = musculoskeletal or connective tissue condition
- S = injury or consequences of external causes
- Digit 2 is numericM00-M25 Arthropathies
(M00-M03) Infectious arthropathies
- (M05-M14) Inflammatory polyarthropathies
- (M15-M19) Arthrosis
- (M20-M25) Other joint disorders
- M40-M54 Dorsopathies
- (M50-M54) Other dorsopathies(M45-M49) Spondylopathies(M40-M43) Deforming dorsopathies
- M60-M79 Soft tissue disorders
- (M60-M63) Disorders of muscles
- (M65-M68) Disorders of synovium and tendon
- (M70-M79) Other soft tissue disorders
- M80-M90 Osteopathies
- M91-M94 Chondropathies
- M95-M99 Other disorders of the musculoskeletal system and connective tissue
- S00-T14 – Injury
- (S00-S09) head
- (S10-S19) neck
- (S20-S29) thorax
- (S30-S39) abdomen, lower back, lumbar spine and pelvis
- (S40-S49) shoulder and upper arm
- (S50-S59) elbow and forearm
- (S60-S69) wrist and hand
- (S70-S79) hip and thigh
- (S80-S89) knee and lower leg
- (S90-S99) ankle and foot
- (T00-T07) involving multiple body regions
- (T08-T14) unspecified parts of trunk, limb or body region
- Digits 3-6 are alpha or numericFor “M” and “S” category codes, the side of the body is indicated. Generally:
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1 = right
2 = leftNote: There are a variety of different methods for denoting bilateral locations
- Decimal is placed after the third character
- 7th digit is a special extension code that will be alphabetical and is required for injury codes that start with S.A: Initial Encounter – Patient is receiving active care. You can use A on multiple claims for the same condition – it really isn’t just for the first encounter. “A” code for initial encounter is used for all sessions related to the “active” treatment for the symptoms called out in the ICD10 code. D: Subsequent Encounter – After patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Rehab therapy is usually considered to be part of the healing and recovery phase. The “D” code is used for subsequent treatments to check on the patient/client after active treatment is completed.S: Sequelae — Complications or conditions that arise as a direct result of the condition that are caused from the direct result of an injury or condition.
- Fractures have a different extension code than other conditions based on open vs. closed, routine vs delayed healing, non-union or malunion.
ICD-10 codes will provide specific locations for injuries. They will also document chronic or acute pain issues. The new codes are much more specific and will provide us with much more information about diseases and their treatments which will help with health management and research.
Since these are diagnosis codes and massage therapists can not diagnose clients, the codes will come from the doctor. The doctor may or may not write the actual description of what the code means so you may have to look the code up to know what it means. It is best to get the actual code from the doctors so that you can put the same code on the bill as the doctor does to tell the insurance that you are working on the same condition. Often times there are a variety of codes that can be used for one condition so it is important to know which one the doctor is using. There are many free code look up databases online. See ICD 10 Look up from CMS.
Here also are some common orthopedic codes that are used for rehabilitation
- M54.2 Cervicalgia
- M50.01 Cervical disc disorder with myelopathy, occipito-atlanto-axial region
- M50.02 Cervical disc disorder with myelopathy, mid-cervical region
- M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
- M54.30* Sciatica, unspecified side
- M54.31 Sciatica, right side
- M54.32 Sciatica, left side
- M54.40* Lumbago with sciatica, unspecified side
- M54.41 Lumbago with sciatica, right side
- M54.42 Lumbago with sciatica, left side
There are specific codes just for pain. It has been previously said that massage therapists can use pain codes to bill the insurance without a prescription. I have never seen a health care plan that does not required massage to be medically necessary which means a prescription is needed. Pain needs to be carefully diagnosed to rule out more severe injuries or conditions like heart attacks, kidney stones etc. Here are common pain codes:
- Shoulder — M25.511 (R), M25.512 (L)
- Upper Arm — M79.621 (R), M79.622 (L)
- Elbow — M25.521 (R), M25.522 (L)
- Forearm — M79.631 (R), M79.632 (L)
- Wrist — M25.531 (R), M25.532 (L)
- Hand — M79.641 (R), M79.642 (L) (excludes fingers)
- Hip — M25.551 (R), M25.552 (L)
- Thigh — M79.651 (R), M79.652 (L)
- Knee — M25.561 (R), M25.562 (L)
- Lower Leg — M79.661 (R), M79.662 (L)
- Ankle — M25.571 (R), M25.572 (L) (excludes foot/toes)
- Foot — M79.671 (R), M79.672 (L) (excludes toes)
- Thoracic Spine — M54.6
- Low Back Pain — M54.5
As you can see, these codes are much more specific so that will give you so much more information and tracking the codes will provide data for various conditions to see what therapies work best.
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There is much more to billing insurance then just putting an ICD-10 code on a bill. Learn to bill insurance and see my plan to get massage therapy covered by health insurance in every state in my book : Massage Insurance Billing.
Other resources:
CMS Provider resources
World Health Organization
Originally written Aug 6th 2015. Updated Jan 30 2016, Updated 05/25/2019
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This post was last modified on December 11, 2024 1:05 pm