Other cervical disc degeneration, cervicothoracic region M50. 33 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM M50. 33 became effective on October 1, 2021.
ICD-10 code M50. 122 for Cervical disc disorder at C5-C6 level with radiculopathy is a medical classification as listed by WHO under the range - Dorsopathies .
36 - Other intervertebral disc degeneration, lumbar region is a topic covered in the ICD-10-CM.
M51. 36 Other intervertebral disc degeneration, lumbar region - ICD-10-CM Diagnosis Codes.
A cervical disc displacement occurs when there is a herniation or protrusion between discs in the spine. The bones that form the spine, referred to as vertebrae, feature discs between each bone to protect and allow for flexible movement of the back.
92.
However, degenerative disc disease and osteoarthritis are different conditions and can occur separately: one can have degenerative discs without any facet osteoarthritis; or one can have facet osteoarthritis without degenerative discs.
Degenerative disc disease or DDD can be the cause of many different symptoms resulting in localized pain or pain that radiates down the leg. Degenerative joint disease or DJD is very different, but can have overlapping symptoms with DDD.
According to Coding Clinic: “Assign code M16. 0—Bilateral primary osteoarthritis of hip for degenerative changes of hips”. Coding Clinic's rationale is, “ICD-10- CM's Alphabetic Index under “Degeneration, joint disease” instructs “see Osteoarthritis.”
9: Dorsalgia, unspecified.
How is degenerative disc disease diagnosed? A diagnosis is based on a medical history and a physical examination, as well as the symptoms and the circumstances where the pain started. Magnetic resonance imaging can show damage to discs, but it alone cannot confirm degenerative disc disease.
A: OA, or degenerative joint disease, is identified in categories M15-M19 of the ICD-10-CM manual. This is the most common type of arthritis in the elderly. If the arthritis is ever in the spine, refer to category M47, Spondylosis.
ICD-10 code M54. 5, low back pain, effective October 1, 2021. That means providers cannot use M54. 5 to specify a diagnosis on or after October 1—and existing patients with the M54. 5 diagnosis will need to be updated to a valid ICD-10 code.
89.29 or the diagnosis term “chronic pain syndrome” to utilize ICD-10 code G89. 4. If not documented, other symptom diagnosis codes may be utilized.
M19. 90 - Unspecified osteoarthritis, unspecified site | ICD-10-CM.
ICD-10 Code for Intervertebral disc disorders with radiculopathy, lumbar region- M51. 16- Codify by AAPC.
In a Japanese study evaluating 497 asymptomatic patients, Matsumoto et al. showed almost 90% of patients (men and women) over 60 years of age had abnormal findings while 17% and 12% of men and women respectively, in their 20s demonstrated abnormalities. [10] Several studies have acknowledged the most common disc-level involved in degeneration was C5-6, and the second most common being C6-7. Research has also demonstrated that cervical DDD was associated with lumbar degenerative changes in both men and women but did appear later in life. An association has also been found in the pain distribution in the neck-shoulder-brachial region in patients with moderate to severe cervical DDD. [9][10][11]
The degenerative process of the cervical spine classifies into three distinct stages: (1) dysfunction, (2) instability, and (3) stabilization. Dysfunction occurs between the ages of 15 to 45 years old. During this stage, radial and circumferential tears can occur in the annulus accompanied by facet joint localized synovitis. Instability (2) can occur in individuals between the ages of 35 to 70 years old. This stage is characterized by disruption of the inner disc with progressive resorption, as well as facet joint degeneration. This condition leads to the final stage of the process, stabilization, occurring most commonly after 60 years of age. Here, hypertrophic bone develops around the facet joints as well as the disc, promoting stiff and possible ankylosing spine.
There are a variety of surgical approaches to the cervical spine. Commonly, the neural structures become compressed anteriorly; therefore, an anterior approach is necessary to directly remove a disk, causing decompression and will most likely include a fusion (ACDF). The approach of choice in patients with normal to kyphotic alignment is the anterior approach as a laminectomy in these patients may further cause kyphosis secondary to the destabilization that occurs.[36] During an ACDF, compressive and degenerative structures are removed with a fusion across the segments adjacent to the decompression. Furthermore, several disks can be removed with multi-level fusions (with or without strut graft). A corpectomy with strut grafting may be necessary for multi-level decompressions. An anterior cervical plate can be inserted to increase stability and earlier mobilization. Distraction across the disk space with an interbody implant can lead to further indirect decompression of the neural foramen.
Pain, or in combination with other neurological symptoms, may require surgical intervention. Treatment options range from nonoperative measures to decompression, instrumented fusion, or a combination of both laminoplasty or instrumentation or a combination of both. This chapter will examine the anatomy, natural history, etiology, pathophysiology, evaluation, and treatment options. This activity outlines the cause, prevention, and treatment of patients with cervical disc disease and highlights the importance of the need for an interprofessional team.
Treatment for cervical disc disease is centered around decreasing pain, improving function, and minimizing recurrence and duration of symptoms. Treatment typically beings with nonoperative care and can lead to operative intervention.
The intervertebral disc (IVD) is found from the C2-C3 level down, aids in cervical spine mobility and stabilization. In contrast to the thoracic and lumbar vertebrae, the cervical vertebrae have a unique bony prominence called the uncinate process, which articulates with the adjacent level to form the joint of Luschka or uncovertebral joint. This joint helps to reinforce the IVD and provides additional stability and motion.[1] The IVD is an intricate structure composed mainly of two parts, the peripherally located annulus fibrosus (AF) and the centrally located nucleus pulpous (NP) which are responsible for its’ load distribution function. The anterior and posterior longitudinal ligaments reinforce the IVD.
Physical therapy should start early in the treatment algorithm. Passive modalities should be used and include but are not limited to heat, mechanical traction, massage, and a soft cervical collar.[26] Heat has shown to decrease pain and reduce muscle spasms. [27][28] Evidence suggests cryotherapy can help decrease inflammation and reduce muscle guarding. [29][30] Massaging the area of intensity allows for mechanical stimulation leading to an increase of circulation and the promotion of muscle relaxation.[31] Cervical traction may allow for joint distraction and potentially relieving pressure off nerve roots/disks; this may improve epidural blood flow in the area and reduce pain, inflammation, and spasms.
These spinal disc codes appear to be a bit complex, but with some study and evaluation, the logic used to create them becomes clear. The provider can use the codes to guide proper documentation and the coder then can select the right codes with confidence.
It is already included in the code. Likewise, don’t code sciatica (M54.3-) if you code for lumbar disc with radiculopathy. It would be redundant. On a side note, lumbar radiculopathy (M54.16) might be used if pain is not yet known to be due a disc, but it radiates from the lumbar spine.
The codes for the anterior spinal fusion are 0SG00AJ (L4-L5) and 0SG30AJ (L5-S1) . Two codes are also assigned for the posterior spinal fusion, 0SG0071 (L4-L5) and 0SG3071 (L5-S1) . Codes 0SB20ZZ and 0SB40ZZ are also assigned for the discectomy performed at two different levels of the spine. Lastly, code 0QB20ZZ is assigned for the harvesting of the right iliac crest bone graft.
The implementation of ICD-10-PCS has enhanced the skills of coding professionals as it contains many unique features that provide an opportunity to accurately reflect the complexity of the procedures being performed. The assignment of ICD-9-CM procedure codes for spinal fusions often challenged coding professionals, and this has not changed with the transition to ICD-10-PCS. As with the coding of other complex surgical procedures, coding professionals struggle with identifying which portion of the spinal fusion procedure to code or not to code.
The code for this procedure is 0QB20ZZ, with the body part character (fourth character) being 2 for right pelvic bone. The iliac crest does not have its own distinct body part value in ICD-10-PCS, with the ICD-10-PCS Body Part Key indicating that the pelvic bone is the closest proximal branch.
If a mixture of autologous and nonautologous bone graft (with or without biological or synthetic extenders or binders) is used, the procedure is coded with device value Autologous Tissue Substitute (7)
Qualifier: The qualifier character identifies the column of the spine being fused (anterior or posterior) and if the surgical approach is from the front or back of the body (see Figure 1 below).
As with Examples #1 and #2, the segmental instrumentation is included in the spinal fusion and is not coded separately. The lumbar decompression L4-L5 and L5-S1 bilateral foraminotomies and L3 decompression laminectomy are also considered to be integral to the spinal fusion and not coded separately.