Neurosurgery Coding Alert

Notice if the surgeon documented Schmorl’s nodes.

When it comes to intervertebral disc disorders, you have a lot to think about including the level of the cervical disc displacement, whether the surgeon documented Schmorl’s nodes, and your options for disc degeneration.

Check out the following tips to make sure you know which ICD-10 choices you can look to when it comes to intervertebral disc disorders.

Tip 1: Identify Correct Levels For Cervical Disc Displacement

When reporting displacement of cervical intervertebral disc, you must specify the precise location of the displacement in the cervical region, i.e. high or mid cervical, or displacement at the cervicothoracic region. Take a look at your possible choices:

• M50.21 (Other cervical disc displacement, high cervical region)
• M50.220 (… mid-cervical region, unspecified level)
• M50.221 (… at C4-C5 level)
• M50.222 (… at C5-C6 level)
• M50.223 (… at C6-C7 level)
• M50.23 (… cervicothoracic region).

When your surgeon does not specify location of the displacement in the cervical region, you should report M50.20 (Other cervical disc displacement, unspecified cervical region).

Tip 2: Look to These Codes For Thoracic and Lumbar Disc Displacement

When the surgeon documents a displacement of an intervertebral disc in the lumbar and lumbosacral regions, you would look to the following two codes:

• M51.26 (Other intervertebral disc displacement, lumbar region)
• M51.27 (… lumbosacral region).

“The diagnosis code M51.27 would only apply to an L5S1 disc displacement, but it is unclear the rationale to separately identify disc displacements at this single location when compared with other lumbar disc locations,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

And, when the surgeon documents displacement of a thoracic and thoracolumbar intervertebral discs, you would look to the following codes:

• M51.24 (Other intervertebral disc displacement, thoracic region)
• M51.25 (… thoracolumbar region).

Unspecified: When the surgeon does not specify the location of the displacement in the thoracic or lumbar region, you should report M51.9 (Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder).

Tip 3: Pay Close Attention to Schmorl’s Nodes

ICD-10 offers specific codes for Schmorl’s nodes in various regions of the vertebral column.

Schmorl’s nodes defined: Schmorl’s nodes, also called Schmorl’s nodules, are protrusions of disc material into the adjacent vertebral bone. The cartilage of the intervertebral disc, the disc between two spine bones, protrudes into the adjacent vertebra. “This represents a degenerative disc condition on the continuum of other degenerative changes seen in the aging spine,” Przybylski says.

When the surgeon diagnoses Schmorl’s nodes, you must check the location of the nodes.

• For the thoracic region, you would report M51.44 (Schmorl’s nodes, thoracic region).
• For the thoracolumbar region, you can look to M51.45 (… thoracolumbar region).
• For the lumbar region, turn to M51.46 (… lumbar region).
• For the lumbosacral region, your choice is M51.47 (…, lumbosacral region).

Tip 4: Dig Deeper Into Regions For Disc Degeneration 

If the surgeon documents cervical intervertebral disc degeneration, you should know that you have specific options for high, mid, and low cervical regions. The following are the codes you will choose depending upon which part of the cervical region is affected:

• M50.30 (Other cervical disc degeneration, unspecified cervical region)
• M50.31 (… high cervical region)
• M50.32 (… mid-cervical region)
• M50.33 (… cervicothoracic region).

However, if the surgeon documents degeneration of thoracic or lumbar intervertebral discs, you would look to the following codes:

• M51.34 (Other intervertebral disc degeneration, thoracic region)
• M51.35 (…, thoracolumbar region)
• M51.36 (…, lumbar region)
• M51.37 (…, lumbosacral region).

Tip 5: Take Notice of Cervical Disc Disorders With Myelopathy

Myelopathy is a neurological disorder due to compression of the spinal cord. A myelopathy can be cervical, thoracic, or lumbar. If the patient has a cervical disc disorder with myelopathy, you can look to the following ICD-10 codes:

• M50.00 (Cervical disc disorder with myelopathy, unspecified cervical region)
• M50.01 (…, high cervical region)
• M50.020 (…, mid-cervical region, unspecified level).

Additionally, notice these ICD-10 choices for different cervical disc levels:

• M50.021 (Cervical disc disorder at C4-C5 level with myelopathy)
• M50.022 (… at C5-C6 level with myelopathy)
• M50.023 (… at C6-C7 level with myelopathy).

Example: The surgeon documents that the patient has a cervical disc disorder with myelopathy of the high cervical region. You would report M50.01 for this diagnosis.