ICD-9/ICD-10 CHIROPRACTIC HISTORY Chiropractic Pioneer, Dr. K. S. J. Murkowski

The concept of the International Statistical Classification of Diseases (ICD) started in the 1600s with John Graunt who kept disease statistics for the London Bills of Mortality. At this time. London was one of the main centers of health care and statistics and diagnostic coding started in 1839 with the London Bills of Mortality. In 1893. the first edition of the International List of Causes of Death was revised by the International Statistical Institute. This went into the International List of Causes of Death in 1937. With years of searches and statistics, this evolved into the International Classification of Causes of Death in 1938. The World Health Organization (WHO) was founded on April 7. 1948. The WHO then started to use information to track morbidity and mortality to make statistical assessments for international health and disease trends. In 1950. there was another name change to the International Classification of Diseases. Hospitals and doctors in the US then started to classify and index diseases (care). In 1967. the World Health Assembly adopted the WHO nomenclature of ICD. In February 1977. the National Center for Health Statistics had a committee for the development of a clinical modifica­tion of ICD-9. This modification included indexing healthcare records, healthcare reviews, ambulatory care, healthcare programs, basic health statistics, etc. In 1988. the American Chiropractic Association (ACA) and International Chiropractors Association (ICA) received an "invitation" from the WHO to choose a representative to help revise the ICD-9 codes for ICD-10-CM. In 1989. the AC A and ICA agreed that Dr. K. S. J. Murkowski (our father and my best friend) would represent all chiropractors to the World Health Organization on ICD-10. For more than five years. Dr. Murkowski was the chairman of the ACA/ICA Committee on ICD-10. He conceived and formulated more than 500 suggested codes for the vertebral subluxation complex (VSC) and its eight physical and eight chemical components. Dr. Murkowski attended and testified at numerous WHO hearings in front of the seven heads (MDs) of the WHO. These doctors and their representatives then took Dr. Murkow ski"s recommendations back to their respected countries for consid­eration and approval. This was a difficult task at best for a DC representing chiropractic to convince MDs. pliarmaccutical companies, etc.. to support chiropractic codes and concepts for the ICD-10 codebook. For example, in Dr. Murko\vski"s first testimony at the Lister Hill Auditorium in Bcthcsda. Man land (next to the Bcthcsda Hospital), he had a unique experience. More than 5.000 people attended and more than 3.000 did not speak English. Dr. Murkowskfs instructions were that he had twenty minutes to present his testimony, and he was allowed no handouts or use of overhead projectors. What a great challenge! After the first hearing, they requested that Dr. Murkowski pro­vide an official definition of the vertebral subluxation complex. It took approximateh two years for the ACA and ICA to agree on the definition of "subluxation": the chiropractic subluxation complex is an alteration of the biomcchanical and ncurophysi-ological dynamics of the contiguous spinal and paraspinal structures, which cause ncuronal disturbances). This definition was agreed to and signed at a joint ACA and ICA meeting in Carmcl. California for the presentation to the WHO for ICD 10. There are approximately 300 different definitions of sublux­ation. so it was imperative that the ACA and ICA finalh agreed upon a definition of the chiropractic subluxation complex for thcWHOandICD-10-CM. Throughout history, the chiropractic definition of VSC has changed multiple times. Drs. D. D. and B. J. Palmer changed it three times from 1906 to 1934 (Vol. 1: The Science of chiropractic, Pg. 13-Palmer 1906: Vol. 3 The Science of chiropractic. Pg 99. Palmer 1911: Vol. XVIII. The Subluxation Specific. The Adjustment Specific. Pg. 77-78 Palmer 1934). The major difference between a chiropractic subluxation (hypomobility) and the medical subluxation (hypermobility) is the difference in the treatment of subluxation today between allopathic and chiropractic physicians. Dr. Murkowski also sent a letter to the Department of Health and Human Sen ices (HHS) upon their request stating that normally 12 visits arc considered standard before a rec\ aluation is done, unless the chiropractic patient has a new incident. The HHS indicated that they thought three visits for chiropractic was good until Dr. Murkowski stated 12 visits was the normal standard of care. Recently in Las Vegas. Nevada. David Chapman-Smith reminisced with Dr. Murkowski. He told Dr. Murkowski that he had received numerous communications from WHO members who had informed him that Dr. Murkowski was not only articulate, expressive, and had a unique way of getting his points across, but more importantly, he was tenacious for the chiropractic profession for more than five years. The WHO members agreed chiropractic would receive codes in the new ICD-10 manual based on Dr. Murkowski's presentations. Dr. Murkowski was recently interviewed regarding the new ICD-10 codes. He stated. "It was indeed and honor and privilege to serve all of chiropractic as the past chair­man of the ACA/ICA ICD-10 commit­tee, and to ensure ICD-10 Codes that all chiropractors now and in the future could use that would help benefit all chiropractic patients. It has taken almost 20 years for the new ICD-10 codebook to be revised and finally put into a form that will be adopted in October 2014 by general practitioners. Dr. Murkowski recom­mends you look at chapter 6 and 13: M+S Sections for basic chiropractic usage and more specific ICD-10 CM Codes. Dr. Murkowski is currently teaching ICD-10 seminars for Foot Lcvclcrs. Mas­ter Practice Counselors, and ChiroSccurc Insurance on the proper utilization of the ICD-10 codes that he conceived, revised, and submitted for over five years. In our opinion. Dr. Murkowski is our ICD-10-CM chiropractic champion, innovator, and pioneer. Dr. Murkowski wishes to remind all DCs and CAs today of the following: Please update your HIPAA manu­als and training with the new changes of September 13. 2013. Start testing the new CMS-1500 form with the 12 diagnostic slots, effective April 1.2014. Train and prepare now for the new ICD-10 codes that go into effect on Octo­ber 1. 2014. Dr. Murkowski states that the key to success today is that the DC must paint a diagnostic picture of the patient for third parties with ICD codes and corollar­ies. More precise ICD codes with more complex patients" VSC conditions and components will result in the length of care recognized and allowed by third parties. Practitioners also are reminded in all of Dr. Murkowskfs seminars that a Medicare diagnosis has ICD category I. II and III for levels or severity. He also wants to remind all DCs and CAs today to currently use the ICD-9 and the diagnostic corollaries until September 30. 2014. ICD-10-CM codes start on Wednesday. October 1. 2014. On a positive note. Dr. Murkowski states that the ICD-9 and ICD-10 codes do not change the Current Procedural Ter­minology (CPT) codes, which are used on the CMS-1500 for reimbursement. The new CMS-1500 with 12 diagnosis slots goes into effect on April 1. 2014 (April Fool"s Day). Some examples of differences between ICD-9 and ICD-10 arc as follows: SubluxationC 1-739.1 or 839.01 (ICD-9/ICD-10C1/C2-S13.12) In the ICD-10. there are now seven characters starting with an alpha letter prefix with additional classifications: initial en­counter (S13-110A. Cl). subsequent encounter (after care or follow up. S13.110D). or S = sequela (complications as a result of an injury) SI 3.110S. A sprain of the neck (whiplash. 847.0 ICD-9) could be S13.4XXA. anterior longitudinal ligament, atlantal axial joints, and whiplash injury. Doctors today may have to use a code map or GEMS (general equivalent mapping). DCs will have to be specific about condi­tions that affect the right or left side of the body. For example, ICD-9 Sciatica: 724.3. ICD-10 M54.30 Sciatica unspecified. M54.31 Sciatica Right Side (1 = Right Side). M54.32 Sciatica Left Side (2 = Left Side). Another example is headache: (784.0 ICD-9-CM) to ICD-10-CM R51: vascular headache G44.1: (307.81 ICD-9) ten­sion headache G44.209; (339.00 ICD-9) cluster G44.009: and (346.10 ICD-9) migraine headache G44.009. Dr. Murkowski feels that it is not difficult to learn the new ICD-10 codes with the proper seminar instruction and examples. There is no automatic crossover for all ICD-9 codes to the new ICD-10 codes. In some cases, there may be multiple choices. Learning new ICD codes for the first time is like learning a new chiropractic technique. The more you sec it and use it. the easier it will be. The ICD-10 codes will offer more specificity, which will enhance the patient's treatment plan and third-party understanding for reimbursement. Better diagnosis and documentation translates to better care for the patient and chiropractic! Detailed exams, review of systems, x-rays, treatment plans, and chart/SOAP notes to supplement electronic health record (EHR) systems will all be necessary to integrate so that all will benefit. Dr. Murkowski was recently quoted in an interview that he was happy that his years of work and sen ice to the WHO on behalf of the ACA. ICA. and all of chiropractic would now benefit chiropractic, chiropractors, and their patients today and for many years to come with the use of the new ICD-10 codes. He is extremely optimistic that DCs now have more opportuni­ties to deliver primary health care with the Affordable Care Act section 2406 (a). "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that provider's license or certification under applicable state law." This, along with the fact that the ICD codebook and the CPT codebook arc not license-specific, affords greater opportunities for chiropractic in the future for active care and rehab for more functional capacity. Dr. K. S. J. Murkowski is available for state conventions, local chiropractic meetings, and MPC concierge coaching for individual DCs and CAs. He can be reached at (517) 784-9123. or visit www.northwcstchiropracticlifcccnter.com with a link to the MPC shopping cart for books and fonns that make your ICD/CPT daily record keeping easy for all!