Neurosurgery Coding Alert

Question: What diagnosis codes can we submit for a patient who presents with a subluxation of the lumbar and sacral spine with degeneration of disc(s) in the lumbar region?

Mississippi Subscriber

Answer: You can report 739.3 (Nonallopathic lesions of lumbar region, not elsewhere classified) as the primary diagnosis, followed by a secondary diagnosis of 722.52 (Degeneration of lumbar or lumbosacral intervertebral disc). In addition, you submit code 739.4 (Nonallopathic lesions of sacral region, not elsewhere classified). However, note that you must have a neuromuscular complaint as well to report 739.4.  Additional ICD-9 codes describing lumbosacral subluxation include 756.11 (Congenital spondylolysis lumbosacral region) and 756.12 (Spondylolisthesis congenital).

Noridian Medicare states “If you need to document more than four diagnosis codes, as will be the case any time there are more than two regions billed, the additional diagnoses must be present in the medical record.

Future forward: When ICD-10 is implemented next month, these diagnosis codes will change. For example, 739.3 in ICD-9 would map to M99.83 (Other biomechanical lesions of lumbar region) in ICD-10. The category M99 refers to “Biomechanical lesions, not elsewhere classified.”

The ICD-9 secondary diagnoses of 722.52 would map into two ICD-10 CM codes: M51.36 (Other intervertebral disc degeneration, lumbar region) and M51.37 (Other intervertebral disc degeneration, lumbosacral region). These come under the category of “Other dorsopathies.” However, you cannot include a current injury scenario with these codes. The ICD-9 tertiary diagnosis code 739.4 would map into ICD-10 CM code M99.84 (Other biomechanical lesions of sacral region)