Q78.9 — Osteochondrodysplasia, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- NUCCA assessment descriptions used in studies: objective x-ray views of the head and neck ("By using precise and objective x-ray views of the head and neck, mathematical measurement and analysis are made of the misalignment.") and clinical tests such as the supine leg check (leg length inequality), Anatometer (standing posture), Gravity Stress Analyzer, and hip calipers.
- Radiographic documentation for lumbar lordosis measurement in CBP/extension traction studies: radiographic measured lordosis (examples: L1 to L5 absolute rotation angle [ARA], L1 to L5 Cobb angle, T12 to S1 ARA) — used as outcome measures in trials (Oakley et al, 2020).
- Blood pressure measurements in studies of atlas realignment for hypertension (Bakris et al, 2007): serial BP recordings (baseline and week 8 comparisons).
Key Coverage Criteria
- NUCCA (National Upper Cervical Chiropractic Association) atlas realignment — pilot randomized, placebo-controlled study reported 'restoration of Atlas alignment was associated with marked and sustained reductions in BP similar to the use of 2-drug combination therapy' (Bakris et al., 2007) — i.e., potential benefit for stage 1 hypertension in a single-center pilot trial.
- Chiropractic services are medically necessary when ALL of the following criteria are met: (1) the member has a neuromusculoskeletal disorder; (2) the medical necessity for treatment is clearly documented; and (3) improvement is documented within the initial 2 weeks of chiropractic care.
- If improvement is not documented within the initial 2 weeks, additional chiropractic treatment is considered not medically necessary unless the chiropractic treatment is modified.
- If no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary.
- Once the maximum therapeutic benefit has been achieved, continuing chiropractic care is considered not medically necessary.
- Home-based chiropractic service is considered medically necessary in selected cases based upon the member's needs (i.e., the member must be homebound). This may be considered medically necessary in the transition of the member from hospital to home, and may be an extension of case management services.
2 Active Policies
AETNA-CPB-0107 — Chiropractic Services
AETNA-CPB-0582 — Titanium Rib
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.