Neurosurgery Coding Alert

Regions guide your coding for disc displacement, degeneration, disorders with myelopathy, and Schmorl’s nodes. 

When you transition to ICD-10, you will adopt more specific codes for intervertebral disc disorders. This is because there will be new codes for disorders at junction of two regions, for example, the cervicothoracic, thoracolumbar, and lumbosacral regions. Check out what ICD-10 has in store.

Check Levels for Cervical Disc Displacement

For displacement of cervical intervertebral disc, you submit ICD-9 code 722.0 (Displacement of cervical intervertebral disc without myelopathy). For ICD-10, you will specify the precise location of the displacement in the cervical region, i.e. high or mid cervical, or displacement at the cervicothoracic region. Accordingly, you submit ICD-10 codes M50.21 (Other cervical disc displacement, high cervical region), M50.22 (Other cervical disc displacement, mid-cervical region), or M50.23 (Other cervical disc displacement, cervicothoracic region). When your surgeon does not specify location of the displacement in the cervical region, you report ICD-10 code M50.20 (Other cervical disc displacement, unspecified cervical region).

Expect Beyond Direct Mapping in Thoracic and Lumbar Disc Displacement

When your surgeon documents a diagnosis of displacement of lumbar intervertebral disc, you submit ICD-9 code 722.10 (Displacement of lumbar intervertebral disc without myelopathy). This code maps to two ICD-10 codes: M51.26 (Other intervertebral disc displacement, lumbar region) for displacement in lumbar region and M51.27 (Other intervertebral disc displacement, lumbosacral region) for displacement in lumbosacral region.

“This would seem only to apply to an L5S1 disc displacement, but it is unclear the rationale to separately identify disc displacements at this single location,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

For displacement of the thoracic intervertebral disc, you report ICD-9 code 722.11 (Displacement of thoracic intervertebral disc without myelopathy). The corresponding ICD-10 codes are M51.24 (Other intervertebral disc displacement, thoracic region) and M51.25 (Other intervertebral disc displacement, thoracolumbar region). 

How is ICD-10 different? ICD-10 codes for displacement in the thoracic and lumbar regions are more location specific. There are codes that you can submit for displacements at the junction of two regions, i.e. M51.25 for displacement at the thoracolumbar region and M51.27 for that in the lumbosacral region. 

When your surgeon does not specify the location of the displacement in the thoracic or lumbar region, you should report ICD-9 code 722.2 (Displacement of intervertebral disc site unspecified without myelopathy). The direct match for this code in ICD-10 is M51.9 (Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder).

Location Guides Coding for Schmorl’s Nodes

Like in ICD-9, ICD-10 offers specific codes for Schmorl’s nodes in various regions of the vertebral column. However not all codes have a direct one-to-one match.

What are Schmorl’s nodes? Schmorl’s nodes, also called Schmorl’s nodules, are protrusions of disc material into the adjacent verterbral bone. The cartilage of the intervertebral disc (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 your surgeon diagnoses Schmorl’s nodes, you first need to check the location for the nodes. For Schmorl’s node in the thoracic and lumbar region, you have ICD-9 codes 722.31 (Schmorl’s nodes of thoracic region) and 722.32 (Schmorl’s nodes of lumbar region), respectively. Each of these codes maps to two codes in ICD-10. Code 722.31 maps to M51.44 (Schmorl’s nodes, thoracic region) and M51.45 (Schmorl’s nodes, thoracolumbar region) in ICD-10. Similarly, 722.32 maps to ICD-10 codes M51.46 (Schmorl’s nodes, lumbar region) and M51.47 (Schmorl’s nodes, lumbosacral region).

When your surgeon documents the Schmorl’s node in any other part of the vertebral column, you submit ICD-9 code 722.39 (Schmorl’s nodes of other spinal region). For ICD-10, you turn to M51.9 (Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder). If however, your surgeon does not specify where in the vertebral column was the Schmorl’s node located, you submit ICD-9 code 722.30 (Schmorl’s nodes of unspecified region). This code again maps to ICD-10 code M51.9. 

Dig Deep Into Regions for Disc Degeneration 

For cervical intervertebral disc degeneration, you submit ICD-9 code 722.4 (Degeneration of cervical intervertebral disc). However, in ICD-10, you will have specific options for high, mid, and low cervical regions. The following are the codes you will choose for ICD-10 depending upon which part of the cervical region is affected:

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

For degeneration of thoracic or lumbar intervertebral disc, make note of additional codes in ICD-10 for disc degeneration at the thoracolumbar and lumbosacral regions. In ICD-9, you report code 722.51 (Degeneration of thoracic or thoracolumbar intervertebral disc) for degeneration of thoracic or thoracolumbar intervertebral disc. ICD-10 offers the following two specific codes: 

• M51.34, Other intervertebral disc degeneration, thoracic region
  
• M51.35, Other intervertebral disc degeneration, thoracolumbar region
  

Similarly, the ICD-9 code 722.52 (Degeneration of lumbar or lumbosacral intervertebral disc) maps to codes M51.36 (Other intervertebral disc degeneration, lumbar region) and M51.37 (Other intervertebral disc degeneration, lumbosacral region) in ICD-10.

Navigate Regions for Myelopathy

When reporting codes for disc disorders with myelopathy, you will continue to check the region involved in ICD-10 as you do in ICD-9. However, you are mistaken if you think you have a one-to-one match for all codes. Table 1 lists the ICD-9 and ICD-10 codes that you report for intervertebral disc disorder with myelopathy.

“Keep in mind that the spinal cord is only present in the spinal canal down to approximately the L1 level in most people. Therefore, myelopathy in the lumbar region is unlikely unless a high lumbar disc displacement causes a conus medularis compression,” Przybylski says.