Neurology & Pain Management Coding Alert

Choose your codes based on pathology and anatomical location.

In ICD-10, there are two disc disorder categories to choose from in spinal disc disorders: M50 (Cervical disc disorders) and M51 (Thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders).

“We see this commonly in our older patients and some athletes,” says Elizabeth Earhart, CPC, who works as a coder in Millersville, Penn.

Check out this advice on choosing between the pair of disorders, and get your ICD-10 codes right every time for these patients.

Choose ‘0,’ ‘1,’ or ‘2’ to Represent Disorder

Disc disorders include both the intervertebral disc displacement as well as disc degeneration diagnoses. 

Disc disorders, indicated by the fourth character 0 or 1, represent a combination code of the disc displacement or degeneration diagnosis and an associated complication, such as myelopathy or radiculopathy. 

Disc displacement includes protrusions, bulges, and herniation of the nucleus pulposus (the central part of the intervertebral disc). The ICD-10 fourth character 2 denotes the disc displacement without either of the associated 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
• 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 [primary care physician] involved — if there is one.”

Therefore, we have the following broad sub-categories of ICD-10 codes for cervical disc disorder:

• M50.0-, Cervical disc disorder with myelopathy
• 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.”

In each one of the above ICD-10 codes, you have following four possible options for the fifth character, which indicates the cervical spinal region:

• 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- has an Excludes2 note listing brachial radiculitis NOS (M54.13).  This Excludes2 note indicates that the brachial radiculitis NOS diagnosis is not part of the cervical disc disorder with radiculopathy diagnosis code set. 

Also, you do not need to code cervical radiculitis or radiculopathy separately as M54.1- while coding for M50.1-, as it is already included in the code. The ICD-10 guidelines state: “Multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis.”

Only use the fourth character designation of 8 for the other disc disorders if none of the other fourth character choices fit. Consider all the others first. The ICD-10 official guidelines instruct coders to use the “other” or “other specified” codes when the information in the medical record provides detail for which a specific code does not exist. If you can come up with a cervical disc disorder that does not match one of the other specific choices, then this is the code for you.

Use the fourth character of 9 only for unspecified disc disorders when the information in the medical record is insufficient to assign a more specific code. However, remember that payers may not like it and might ask for further clarification later.

The C50.- ICD-10 category includes a note, “Code to the most superior level of disorder.” So if the documentation indicates multiple levels represented by different fifth characters in the C50.- category, you should code only the most superior level of the disorder.

For example, if the physician’s note indicates the patient has C3-C4 and C4-C5 disc degeneration, the coder would only report the M50.31 (Other cervical disc degeneration, high cervical region). The M50.32 (Other cervical disc degeneration, mid-cervical region) would not be separately coded.

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.”