Orthopedic Coding Alert

Experts: Make sure providers and coders are on the same page for successful transition.

Summer’s winding down, which means that the World Health Organization (WHO) is winding up its final list of ICD-10 code additions, deletions, and revisions for 2018.

The scoop: What stands out in ICD-10 2018 is a new pair of spinal stenosis diagnoses. Orthopedic offices need to educate themselves “in advance regarding the new 2018 ICD-10 codes and effective implementation dates to incorporate the needed changes into their practice,” explains Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska.

And remember, the implementation date for ICD-10 2018 is October 1, 2017. Read on for more information on the changes you’ll need to know so you don’t fall when the new ICD-10 premieres this autumn.

Welcome this Code Pair to Spinal Stenosis Set

There are two changes to the spinal stenosis group of codes.

Added: ICD-10 2018 will feature a pair of new codes in the M48.06- (Spinal stenosis, lumbar region …) family:

• M48.061, … without neurogenic claudication
• M48.062, … with neurogenic claudication.

Previously, you would have had to code neurogenic claudication in lumbar spinal stenosis with M48.06.

Impact: These additions will help you paint a better portrait of your lumbar spinal stenosis patients’ conditions, thereby leading to more accurate treatment and betterpatient outcomes. ICD-10 2018 “continues to enhance proper diagnosis coding by incorporating greater clinical details and specificity. Terminology and disease classification updates are more consistent with current clinical practice,” Swanson explains.

This ICD-10 change will flesh out the spinal stenosis coding family, which will read thusly on October 1, 2018 (new codes in bold):

• M48.00, Spinal stenosis, site unspecified
• M48.01, … occipito-atlanto axial region
• M48.02, … cervical region
• M48.03, … cervicothoracic region
• M48.04, … thoracic region
• M48.05, … thoracolumbar region
• M48.061
• M48.062
• M48.07, … lumbosacral region
• M48.08, … sacral and sacrococcygeal region.

Look for These Neurogenic Claudication Symptoms

When deciding between M48.061 and M48.062, it will help to know more about neurogenic claudication.

Definition: “Neurogenic claudication is the medical term used to describe the symptom of pain induced by walking,” according to spinal-healthcare.com, which goes on to call the condition “a hallmark symptom of lumbar stenosis.”

For claims on or after October 1, be sure to check for signs of trouble walking in the operative notes for your lumbar spinal stenosis patients. If there is no evidence of ambulatory issues or other signs of neurogenic claudication, you’ll choose M48.061; if the notes indicate the patient has ambulatory issues due to stenosis, however, this could indicate claudication, in which case you’ll need to consider M48.062.

If the coders and the providers work together to implement this change, they shouldn’t have any issues adjusting to ICD-10 2018, experts say.

“All of the changes or additions to ICD-10 codes are designed to be more specific in diagnostic coding,” explains Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey. “The important thing to remember is the medical record documentation of the diagnosis is specific, so the coder can assign the correct and current ICD-10 code.”