ICD 10 Coding Alert

And add anatomical location for greater accuracy.

Even though there are only two main ICD-10 categories for spinal disc disorders, the sheer number of choices they can create make them excellent for pinpointing specific diagnoses but tricky for coders.

The two categories - M50.0 (Cervical disc disorder with myelopathy) and M51 (Thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders) - encompass many of the spinal disc disorders that Elizabeth Earhart, CPC,  with Godshall Chiropractic in Millersville, PA, says are "commonly seen in our older patients and some athletes." "The goal for us," Earhart continues, "is to help strengthen the muscle in the injured areas, lessen pain, and keep the patient moving."

For coders, the goal of finding the most precise code for the conditions is simplified by knowing that fourth characters 0 or 1 can be used to describe protrusions, bulges, and herniation, while the fourth character 2 can be used to specify disc displacement, which can also include these things, but without nerve root or cord complications.

Crack the Cervical Disc Disorders

Cervical disc disorders in ICD-10 have been assigned a myriad of code choices based on the exact pathology and anatomic location of the problem. M50.- primarily covers the cervical disc disorders. The fourth character indicates the following:

• 0: Disc disorder with myelopathy
• 1: Disc disorder with radiculopathy
• 2: Other disc displacement
• 3: Other disc degeneration
• 4: Schmorls notes not in cervical
• 8: Other disc disorders
• 9: Unspecified.

"Having this many choices makes it easier for the doctor to create a more specific plan in our office for the patient," states Earhart. "Many of our patients want to be educated about their treatment and health as well as sharing their information with the PCP involved (if there is one)."

Therefore, we have following broad categories of codes:

• M50.0- - Cervical disc disorder with myelopathy, unspecified cervical region
• M50.1- - Cervical disc disorder with radiculopathy
• M50.2- - Other cervical disc displacement
• M50.3- - Other cervical disc degeneration
• M50.8- - Other cervical disc disorders
• M50.9- - Cervical disc disorder, unspecified.

"With no laterality option for theses codes, we make sure that the notes support the laterality and sometimes the secondary codes," explains Earhart. "If the displacement is causing nerve, muscle, or general pain in the right shoulder, we document and diagnose accordingly."

Now in each one of these, we have following four possible options of the fifth character which indicates the anatomical location:

• 0: Unspecified
• 1: High cervical (C2-C3, C3-C4)
• 2: Mid cervical (C4-C5, C5-C6, C6-C7)
• 3: Cervicothoracic (C7-T1).

Scan Through These Coding Tidbits

Remember that M50.1- (Cervical disc disorder with radiculopathy) has an Excludes2 note that states brachial radiculitis NOS (M54.13), so do not include brachial radiculitis under that code.

Also, you do not need to code radiculitis separately as M54.1- while coding for M50.1- (Cervical disc disorder with radiculopathy), as it is already included in the code.

Only use the fourth character of 8 for the other disc disorders if none of the other fourth character choices fit. Consider all the others first. The official guidelines tell us how to use "other specified" or NEC when we encounter it in a code description. If you can come up with a disc disorder that does not match one of the other choices, then this is the code for you.

Use the fourth character of "9" only for unspecified disc disorders if the documentation does not state anything. However, remember that payers may not like it and ask for further clarification later.

The fifth character option includes transitionary regions. Cervicothoracic is clearly designated as C7-T1.

There is a strange rule for cervical disc disorders that says you should code to the most superior level of the disorder. It seems to imply that you would only code M50.11 even if the problem occurs all throughout the neck. Let us wait till a clarification comes up in an errata later on.

Final takeaway:  "Document to the utmost," reiterates Earhart. "Make sure it's in the notes so if there is a challenge or change to theses codes, it can be supported by the visit notes."