Pain Management Coding Alert

Use the 4^th character to help explain the condition.

ICD-10 brings a wide selection of code choices for cervical disc disorders based on the exact pathology and anatomic location of the problem. Category M50.~ covers most of the conditions, with the fourth character of your code indicating the following:

• 0: Disc disorder with myelopathy
• 1: Disc disorder with radiculopathy
• 2: Other disc displacement
• 3: Other disc degeneration
• 4: Schmorls notes not in cervical
• 8: Other disc disorders
• 9: Unspecified.

Only report the fourth character of “8” for the other disc disorders if none of the other fourth character choices fit. Use the fourth character of “9” only for unspecified disc disorders if the documentation does not state anything. However, remember that payers may not like it and ask for further clarification later.

“Having this many choices makes it easier for the doctor to create a more specific plan in our office for the patient,” says Elizabeth Earhart, CPC, a coder in Millersville, Pa. “Many of our patients want to be educated about their treatment and health as well as sharing their information with the PCP involved (if there is one).”

Therefore, we have following broad categories of codes:

• M50.0~ – Cervical disc disorder with myelopathy, unspecified cervical region
• M50.1~ – Cervical disc disorder with radiculopathy
• M50.2~ – Other cervical disc displacement
• M50.3~ – Other cervical disc degeneration
• M50.8~ – Other cervical disc disorders
• M50.9~ – Cervical disc disorder, unspecified.

“With no laterality option for theses codes, we make sure that the notes support the laterality and sometimes the secondary codes,” explains Earhart. “If the displacement is causing nerve, muscle, or general pain in the right shoulder, we document and diagnose accordingly.”

Each of these categories includes four possible options for the fifth character to indicate the anatomical location:

• 0: Unspecified
• 1: High cervical (C2-C3, C3-C4)
• 2: Mid cervical (C4-C5, C5-C6, C6-C7)
• 3: Cervicothoracic (C7-T1).

Pay attention: Remember that M50.1~ (Cervical disc disorder with radiculopathy) has an Excludes2 note that states brachial radiculitis NOS (M54.13) so do not include brachial radiculitis under that code.

Also, you do not need to code radiculitis separately as M54.1~ when reporting M50.1~, as M50.1~ already includes radiculitis.

Final takeaway: “Document to the utmost,” reiterates Earhart. “Make sure it’s in the notes so if there is a challenge or change to theses codes, it can be supported by the visit notes.”