FY 2022 ICD-10 Changes Effective October 1, 2021

September 20, 2021
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Rick Gawenda
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The fiscal year (FY) 2022 ICD-10-CM codes are to be used for patient encounters occurring from October 1, 2021 through September 30, 2022 as well as for discharges occurring from October 1, 2021 through September 30, 2022. ICD-10-CM codes are used by physical therapists, occupational therapists and speech-language pathologists not only to report the physicians’ medical diagnosis(es) for therapy services, but where allowed, a therapy and/or treatment diagnosis(es) of why a patient requires outpatient physical, occupational and/or speech therapy services.

Changes occuring on October 1, 2021 include ICD-10-CM codes that are used by all 3 disciplines (physical therapy, occupational therapy and speech therapy). A few highlights of changes that become effective on October 1, 2021 include the following:

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Question
If I am changing the ICD-10-CM code, will that require me to do an updated plan of care and recertification for my Medicare patients?

Answer

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Keep in mind that while all of the FY 2022 ICD-10-CM codes are active and do exist, insurance carriers can determine which ICD-10-CM codes they will and will not accept for patients receiving outpatient therapy services. If you have questions concerning ICD-10-CM coverage, contact the specific insurance carrier.

I hope you found this article and all of the resources that were included helpful to your practice. Thank you for being a Gold Member!

All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.


All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. Thank you for this great information, Rick! I know the NCCI Edits are updated quarterly. How often are these diagnosis codes updated? How often are LCDs updated? And, when they are updated, where does one find the updated information? Thanks again for keeping us informed of industry changes and updates! I highly value being a Gold Member.

    1. ICD-10-CM codes are updated yearly with an effective date of October 1 of that year. Thank you for the kind words and being a Gold Member.

      1. Thanks again, Rick! One more question…How often are LCDs updated? And, when they are updated, where does one find the updated information?

        1. How often they are updated depends on the specific MAC and you would find the updated LCDs on your MACs website.

  2. Hi Rick, Thank you so much for keeping us updated on new coding, billing, etc. Your Gold Membership is definitely a necessity in practice during this day and age.
    My question is this: the Alabama section of the APTA has just sent out an email stating that the M54.5 ICD-10 code will no longer be able to be used and that all accounts that currently have this code attached to them for billing will need to be updated on October 1st. Would this need to happen, or would it just be for new accounts opened on or after 10/01/2021?

    You included 3 more specific codes under the M54.5, is this just where the ICD-10 is now requiring the extra digit, like when the ICD-10 manual says “check 4th digit or check 5th digit”?

      1. So to clarify, would we need to change the diagnosis code from M54.5 on existing accounts on 10/01/2021, or just make sure all new accounts have the more specific code starting on 10/01/2021 and going forward?

        1. M54.5 will no longer be a valid ICD-10 code for dates of service on and after October 1, 2021. You will need to use a more specific code.

  3. Rick, will R63.3 still be a valid code or will the newly added, more specific, codes be required?

  4. As a follow up to previous questions – if the patient was already evaluated with the diagnosis code M54.5 – what is the best way to update that Diagnosis code?
    Will we be doing any sort of evaluative note to update the diagnosis code?
    For Medicare patients – are we sending in recertification’s to the MD for signature given there’s a change in Diagnosis code?

    Thank you as always!

  5. Rick, Do you have a more detailed description of the difference for R63.31 & R63.32 for the Acute verse the Chronic? Thank you

    1. Acute would be a sudden onset and chronic would be ongoing, long duration and showing little change or improvement.

  6. We are starting to see BCBS denials when trying to bill M50.30 or M47.819 with 97110 or 97112? We are getting denials saying “the diagnosis code(s) submitted is inconsistent with ICD-10-CM coding guidelines.” When we look up on AAPC, it seems a lot of the low back ICD-10 -related codes are no longer allowable with the 97000 codes. Has anyone else run in to this issue?

    1. I will also add, M50.30 is an unspecified cervical region. I would like to think the PT knows which part of the cervical region is involved.

  7. What resource is available to educate therapists on which codes are available AND meet medical necessity? Is there a list available online?

    1. Most insurance carriers do not provide a list of which ICD-10-CM codes support medical necessity. If you have questions for a certain insurance carrier, you would need to contact that insurance carrier and/or check for therapy policies on their website.