As we previously announced, Academy members met with leaders from First Coast Service Options and Novitas Solutions on November 19 to discuss the list of ICD-10 diagnosis codes in the Billing and Coding Article: Botulinum Toxins and expressed concern about access for patients with spasticity secondary to paralysis resulting from stroke, spinal cord injury, etc. At the conclusion of our collaborative discussion with Novitas and First Coast, a solution to address the potential coding gap for these patients was identified.
We are excited to share that an updated Billing and Coding Article has been published, offering coding clarity. Moving forward, physicians should bill code M62.838 for Other muscle spasm in combination with an appropriate paralysis code (paraplegia, quadriplegia, monoplegia) to capture spasticity secondary to paralysis. The list of paralysis codes can be found at the bottom of the list of ICD-10-CM codes that support medical necessity in the Coding and Billing Article and is also included at the bottom of this message. AAPM&R recommends members review the article in full prior to implementing this coding change in practice. Members with questions can contact the Academy at healthpolicy@aapmr.org.
Your Academy appreciates the advocacy and leadership of our members including Lauren Shapiro, MD, MPH, FAAPMR, Ryan Hafner, MD, FAAPMR, Kimberly Heckert, MD, FAAPMR, and Mary Beth Russell, DO, MS, FAAPMR, who provided essential clinical expertise on short notice to ensure access to care was maintained for this important patient population!
Paralysis codes to be billed with M62.838:
• G82.20 – Paraplegia, unspecified
• G82.21 – Paraplegia, complete
• G82.22 – Paraplegia, incomplete
• G82.50 – Quadriplegia, unspecified
• G82.51 – Quadriplegia, complete
• G82.52 – Quadriplegia, incomplete
• G82.53 – Quadriplegia, C1–C4 level
• G82.54 – Quadriplegia, C5–C8 level
• G83.0 – Diplegia of upper limbs
• G83.10 – Monoplegia of upper limb, unspecified
• G83.11 – Monoplegia of right upper limb
• G83.12 – Monoplegia of left upper limb
• G83.13 – Monoplegia of bilateral upper limbs
• G83.14 – Monoplegia of upper limb, unspecified side
• G83.20 – Monoplegia of lower limb, unspecified
• G83.21 – Monoplegia of right lower limb
• G83.22 – Monoplegia of left lower limb
• G83.23 – Monoplegia of bilateral lower limbs
• G83.24 – Monoplegia of lower limb, unspecified side
• G83.30 – Hemiplegia, unspecified
• G83.31 – Hemiplegia, right side
• G83.32 – Hemiplegia, left side
• G83.33 – Hemiplegia, dominant side
• G83.34 – Hemiplegia, nondominant side