Chiropractic’s favorite word finally gets its due in ICD-10-CM…or does it?

There is a word that has long been held as sacred to the Chiropractic profession.  It is the so-called vertebral “subluxation.”  Medicare defines it reasonably well on behalf of the chiropractic profession:

“A motion segment, in which alignment, movement integrity and/or physiological function of the spine are altered although contact between joint surfaces remains intact.  For the purposes of Medicare, subluxation means an incomplete dislocation, off-centering, misalignment, fixation, or abnormal spacing of the vertebra anatomically.”

A recent OIG report about chiropractors says:

"Medicare requires that chiropractic claims have a primary diagnosis of “subluxation” for payment, but there is no diagnosis code that contains the word “subluxation.” CMS has instructed chiropractors to use the diagnosis codes that indicate nonallopathic lesions of the spine."

These were the 739 codes in ICD-9-CM. The inclusion terms for the 739 codes include “segmental and somatic dysfunction”, but make no mention of the word “subluxation”. Nonetheless, most private payers followed Medicare’s lead and accepted the 739 series as a justification to provide Chiropractic Manipulative Treatment (the 9894X codes from CPT).

In a typical medical dictionary, the term “subluxation” is defined as a “partial dislocation,” which is not how it is defined by many Chiropractors. The spinal codes that actually contained the word “subluxation” (839s) were consistent with the “partial dislocation” view point. Dislocations are often treated with immobilization and/or medication by medical professionals.  In fact, it may be inappropriate to manipulate or adjust a dislocated segment. Some payers did accept the 839 codes, but, using the medical definition, a coder might argue that it does not justify chiropractic treatment. Chiropractors have been compelled to try to fit a square peg into a round hole for many years.  

Along came ICD-10-CM, and it brought a few new considerations, but not necessarily a solution. The clear replacement for 739- codes are the M99.0- codes, which are “segmental and somatic dysfunction”. The word “subluxation” is still missing. However, these are the ones that Medicare contractors have instructed chiropractors to use, and private payers likely follow suit.

The next group of codes in the Tabular List are the M99.1- subcategory, which is defined as “subluxation complex (vertebral)”. These codes are brand new and they appear to use the verbiage most chiropractors use, but, unfortunately, they are not listed on most Medicare approved lists. This may be because the word “subluxation” in these codes still means “partial dislocation”, at least in the eyes of most of the medical profession. Furthermore, General Equivalence Mappings points these codes back to 839s, not 739s, in ICD-9-CM. Since Medicare did not list these codes as acceptable, it appears that they may not be payable, despite the fact that they are valid.

In Chapter 19 of ICD-10-CM, we find several more appealing codes:

• S13.1- for cervical subluxations
• S23.1- for thoracic subluxations
• S33.1- for lumbar subluxations (with the sixth character “0”).

However, these appear to be the matches for the old 839- category. This entire chapter is for acute injuries, and the “includes” list for each of these categories include sprains and other serious traumatic issues. To use these codes, the provider must document a specific interspace, not just a segment, which makes since because these are truly defined as “partial dislocations”. There are no subluxation codes offered in these ranges for L5/S1 or the sacroiliac joints. These codes also require a seventh character to designate the episode of care, which is a bit confusing if you try to force it into the chiropractic model. It appears that these codes are not really ideal for the chiropractically defined subluxation, but work just fine if you are trying to describe a dislocation.

To summarize, use M99.0- codes whenever you used to use 739- codes, unless you get clarification from a payer. If your documentation says “subluxation”, the most correct code would be from the “S” chapter. If you say “subluxation complex”, then use the M99.1- codes. But since both of those are potentially problematic, it may be best to document something like “segmental dysfunction (subluxation)” so that the M99.0- codes are the clear choice. Throwing the word “subluxation” in there in parentheses lets Medicare know that you know that they want to see it, even though you can’t actually code for it.


Dr. Gwilliam, Vice President of the ChiroCode Institute, graduated from Palmer College of Chiropractic as Valediction and became a self-proclaimed certification junkie, earning credentials such as Certified Professional Coding Instructor, Medical Compliance Specialist, and Certified Professional Medical Auditor.  He now provides expert witness testimony, medical record audits, consulting, and online courses for health care providers.  He also writes books and articles for trade journals, and is a sought after seminar speaker.  He is the Vice President and Chief Product Officer of the ChiroCode Institute and Find-A-Code; which provide coding, documentation, and reimbursement guidance and education to physicians and coders.  He has a Bachelor’s degree in accounting, a Master’s of Business Administration, and is one of the few clinicians who became a certified ICD-10 Instructor through the American Academy of Professional Coders. He can be reached at drg@chirocode.com.