Orthopedic Coding Alert

Question: My surgeon's operative report says,"Mild central disk bulge at L4-5 with facet and ligamentum flavum hypertrophy." Which ICD-9 Code should I use for this?
        
Missouri Subscriber

Answer: Your best bet is code 722.10 (Displacement of thoracic or lumbar intervertebral disk without myelopathy; lumbar intervertebral disk without myelopathy). Also report 724.8 (Other symptoms referable to back) to indicate the facet hypertrophy.

The "mild central disk bulge" indicates displacement of the disk. You can assume that the physician examined a lumbar disk because he documented it at "L4-5," and "L" indicates lumbar.
 
Knowing when to assign myelopathy is the real trick. You should only assign a code stating "with myelopathy" if the referring physician explicitly describes the condition in those terms. Myelopathy is a clinical finding, not an image finding, highlighting the need for complete information from the referring physician in the test history.
 
If the history or exam request indicated myelopathy, you would report 722.73 (Intervertebral disk disorder with myelopathy; lumbar region). In simplest terms, myelopathy is a disorder of the spinal cord. You should also check your insurer's understanding of the term. An Ohio Medicare Carrier's local coverage decision, for example, specifies that myelopathy "refers to signs and symptoms suggestive of sensory or motor dysfunction that could be attributed to specific spinal cord or nerve root disorders."