Neurosurgery Coding Alert

Single ICD-9 code expands to four codes in ICD-10.

Radiculopathy gets site-specific for spinal regions in ICD-10. To ensure that your surgeon will be ready when the Oct. 1, 2013 deadline hits, you can reinforce the need for specific region in the operative note in the documentation. Make sure your surgeon mentions the involvement of one or more cervical, thoracic, lumbar or sacral regions.

Review Anatomical Locations

The spine is divided into five regions, namely the cervical, thoracic, lumbar, sacral, and coccygeal regions (Figure 1). 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. The last two regions are fused together and the rest are separated by intervertebral spaces. The coccyx is also called the tail bone. The nerves emerge from the intervertebral foramina 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.

One or more nerves may be inflamed, compressed, or may suffer a compromise in blood supply. This leads to neuropathy in one or more segments called radiculopathy. This may result in pain in the region that is supplied by the individual nerves.

When you report the code(s) for the radiculopathy, the anatomical localization of the neuritis is your best guide. "For example, upper limb pain may represent cervical radiculitis, whereas lower limb pain may represent lumbar radiculitis," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

The regions may overlap, though the nerve roots are discrete. You may often come across a numerical representation in your surgeon's notes. For example, your surgeon 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.

Get Familiar With 4 Specific Codes

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

• M54.14 (Radiculopathy, thoracic region)
• M54.15 (Radiculopathy, thoracolumbar region)
• M54.16 (Radiculopathy, lumbar region)
• M54.17 (Radiculopathy, lumbosacral region)

Remember: Code 724.2 (Lumbago) refers to lumbago or low back pain. You should never have that overlap with M54.17. Though radiculopathy in the lumboscaral region can have a component of low back pain, it is important that you determine the cause of the low back pain. Low back pain has a myriad of possible causes like degeneration of spine, compression due to lesions like a cancerous growth, fracture, muscular strain and many more. "In addition, lumbago as a code cannot be used for surgical procedures as insurance companies will deny payment for that diagnosis," says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.