Neurosurgery Coding Alert

Confirm the site involved to catch the right code.

When reporting a diagnosis of ankylosing spondylitis, remember that ICD-10 calls for more specificity.

ICD-9: You have a single code 720.0 (Ankylosing spondylitis) for ankylosing spondylitis.

ICD-10: Later this year when the ICD-10 applies, you will need documentation in support of the specific site that is affected. Also, you will need to check if the patient is an adult or juvenile.

Confirm Affected Site in the Spine

When your physician documents ankylosing spondylitis in the posterior lower part of the skull at the junction of the head with the neck, you submit code M45.1 (Ankylosing spondylitis of occipito-atlanto-axial region). According to the location of the inflammation in the spinal segment, you report:

• M45.2 (Ankylosing spondylitis of cervical region) for the cervical region,
• M45.4 (Ankylosing spondylitis of thoracic region) for the thoracic region,
• M45.6 (Ankylosing spondylitis lumbar region) for the lumbar region, and
• M45.8 (Ankylosing spondylitis sacral and sacrococcygeal region) for the sacral and coccygeal regions.

“Patients with cervical ankylosing spondylitis often have cervical kyphosis with a flexed posture,” says Przybylski. “Traumatic injury of the cervical spine in this condition requires a high index of suspicion for diagnosis as well as careful treatment.”

Find Specific Codes for Spinal Junctions

When the inflammation involves junctions of two spinal junctions, you will have to choose from specific codes for the junctions. When the junction of the cervical and thoracic regions of the spine are involved, you should report code M45.3 (Ankylosing spondylitis of cervicothoracic region). Similarly, for the thoracolumbar and lumbosacral regions, you report codes M45.5 (Ankylosing spondylitis of thoracolumbar region) and M45.7 (Ankylosing spondylitis of lumbosacral region), respectively.

Earn When Not Sure Of the Sites

You may fail to find any specific site of inflammation in the clinical note. In this case, you can keep up meticulous reporting with code M45.9 (Ankylosing spondylitis of unspecified sites in spine). On the other hand, your physician may document that more than two regions or junctions in the spine are affected by the disease. When you read that multiple sites are involved, you report code M45.0 (Ankylosing spondylitis of multiple sites in spine).

Do Not Forget to Look For Age of the Patient

ICD-10 introduces a specific code for juvenile ankylosing spondylitis. When reporting this condition, you submit code M08.1 (Juvenile ankylosing spondylitis).

When to report juvenile ankylosing spondylitis? Your physician may document ankylosing spondylitis in an adolescent patient or in a teenager. In this case, you submit M08.1 and attach documentation in support of age of the patient.

Note: Juvenile ankylosing spondylitis is also a HLA-B27 positive condition. Most, but not all, patients test positive for this gene.

Also Check Some Other Codes

Besides the codes specific for ankylosing spondylitis, ICD-9 code 720.0 also maps to the following codes for other specified spondylopathies:

• M48.8X1, Other specified spondylopathies, occipito-atlanto-axial region
• M48.8X2, Other specified spondylopathies, cervical region
• M48.8X3, Other specified spondylopathies, cervicothoracic region
• M48.8X4, Other specified spondylopathies, thoracic region
• M48.8X5, Other specified spondylopathies, thoracolumbar region
• M48.8X6, Other specified spondylopathies, lumbar region
• M48.8X7, Other specified spondylopathies, lumbosacral region
• M48.8X8, Other specified spondylopathies, sacral and sacrococcygeal region
• M48.8X9, Other specified spondylopathies, site unspecified.

Note: Like the codes for ankylosing spondylitis, you select a code for other spondylopathies depending upon which region or junction in the spine was affected.