Neurology & Pain Management Coding Alert

ICD-10 choices offer specific 'with' or 'without' terminology.

When a patient has spondylosis with radiculopathy, remember the instructions from ICD-9 coding guidelines Section 1 B. 7: "Signs and symptoms that are routinely associated with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification." Following this guideline means you currently don't separately report 723.4 (Brachial neuritis or radiculitis, NOS) or 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified). The exclusion notes for both 723 and 724 specifically note that this category excludes conditions due to spondylosis. Instead, you

simply report the appropriate spondylosis code (721.1- 721.42), based on the spinal region and whether the provider documents any associated myelopathy.

ICD-10 change: ICD-10, however, will allow coders to specify between spondylosis with radiculopathy versus spondylosis without radiculopathy or myelopathy.

You'll select between M47.2x (Other spondylosis with radiculopathy) or M47.81x (Spondylosis without myelopathy or radiculopathy). Each code group allows you to specify the specific anatomical site, such as the cervical, cervicothoracic, or lumbar region, and more.

Preparation: Once ICD-10 goes into effect in October 2013, your superbill should include all the new code choices. Help your provider understand that the more detailed her documentation is, the less likely the chances that you'll have to resort to the new unspecified codes M47.20 (Other spondylosis with radiculopathy, site unspecified), M47.819 (Spondylosis without myelopathy or radiculopathy, site unspecified) or M47.899 (Other spondylosis, site unspecified).