Neurology & Pain Management Coding Alert

Regions Are Important To Report Radiculopathy

Radiculopathy is site-specific for spinal regions in ICD-10. To ensure that your provider will be ready when the Oct. 1, 2013 deadline hits, you can reinforce the need for specific region notes in the documentation. Make sure your provider mentions the involvement of one or more of the specific spinal regions.

Review Anatomical Locations

The spine is divided into five regions, namely the cervical, thoracic, lumbar, sacral, and coccygeal regions. There are 33 vertebrae that encase the spinal cord. These include the 7 cervical (C1-C7), 12 thoracic (T1-T12), 5 lumbar (L1-L5), 5 sacral (S1-S5), and 4 coccygeal bones (Figure 1). The last two are fused together and the rest are separated by intervertebral spaces. The coccyx is also called the tail bone. The nerves emerge in the intervertebral spaces and the initial segment of the nerves close to the site of their origin from the spinal cord is called 'nerve root'. There are 31 pairs of spinal nerve roots.

Look For the Anatomical Region(s) Involved

Radiculopathy occurs when or more spinal nerve roots become inflamed, compressed, or suffer a compromise in blood supply. This may result in pain, weakness or numbness in the dermatome or region that is supplied by the individual spinal nerve(s).

When you report the code(s) for the radiculopathy, you should look for the spinal region involved. The anatomical localization of the patient's symptoms is your best guide.

The regions may overlap though the nerve roots are discrete. You may often come across a numerical representation in your provider's notes. For example, your physician may report the involvement of the nerve roots at the junction of the last lumbar and first sacral region as L5-S1. In this case, you would report the lumbosacral regional involvement.

ICD-10 Has 8 Specific Codes

In ICD-9, the codes that you use to report radiculitis is 723.4 (Brachial neuritis or radiculitis NOS) or 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified). This sole code covers the radiculopathy in the thoracic, lumbar, and sacral regions. In ICD-10, there are eight possible codes that are used for the specific involved spinal region. These are as follows:

• M54.11 (Radiculopathy, occipital-atlanto-axial region)
• M54.12 (Radiculopathy, cervical region)
• M54.13 (Radiculopathy, cervicothoracic region)
• M54.14 (Radiculopathy, thoracic region)
• M54.15 (Radiculopathy, thoracolumbar region)
• M54.16 (Radiculopathy, lumbar region)
• M54.17 (Radiculopathy, lumbosacral region)
• M54.18 (Radiculopathy, sacral and sacrococcygeal region).

Remember: Code 724.2 (Lumbago) refers to lumbago or low back pain. Radiculopathy in the lumbosacral region can present as low back pain and it is important that you determine the cause of the low back pain. Low back pain has myriad causes. "The common causes include disc degeneration, spondylosis, sprain, muscle trigger point, fibromyalgia, compression fracture, injury," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver. "For many payers, 724.2 does support the medical necessity for several pain management procedures, i.e. intralaminar epidural, facet joint injections, and even transforaminal epidural injections for some payers," says Hammer. "In ICD-10, the only 'Excludes 1' codes for radiculopathy are neuralgia and neuritis NOS (M79.2), radiculopathy with cervical disc disorder (M50.1), radiculopathy with lumbar and other intervertebral disc disorder (M51.1-) and radiculopathy with spondylosis (M47.2-)."