Pain Management Coding Alert

Heads up: Your choices are more specific than in the past. 

All your years of diagnosis coding based on ICD-9 meant you had three choices for patients who had neuritis or radiculitis: 724.4 (Thoracic or lumbosacral neuritis or radiculitis unspecified), 729.2 (Neuralgia neuritis and radiculitis unspecified), or 723.4 (Brachial neuritis or radiculitis NOS).

Now that you’re using ICD-10, you’ll turn to the M54 family for diagnosis options. They are:

• M54.11, Radiculopathy, occipito-atlanto-axial region
• M54.12, Radiculopathy, cervical region
• M54.13, Radiculopathy, cervicothoracic region
• M54.14, Radiculopathy, thoracic region
• M54.15, Radiculopathy, thoracolumbar region
• M54.16, Radiculopathy, lumbar region
• M54.17, Radiculopathy, lumbosacral region
• M54.18, Radiculopathy, sacral and sacrococcygeal region.

Take note: Your previous ICD-9 codes reflecting neuritis or radiculitis expand into radiculopathy codes (M54.11-M54.18). These ICD-10 codes specify precise areas of the spine instead of grouping sites together as in the old system. The expansion is as follows:

• Code 724.4 expands into M54.14, M54.15, M54.16, and M54.17.
• Code 729.2 expands to M54.1-.
• Code 723.4 expands to M54.11, M54.12, and M54.13.

Documentation: Your provider may document any of the following terms for neuritis or radiculitis:

• Brachial neuritis or radiculitis NOS
• Lumbar neuritis or radiculitis NOS
• Lumbosacral neuritis or radiculitis NOS
• Thoracic neuritis or radiculitis NOS
• Radiculitis NOS.

Coder tips: The patient may have conditions that include radiculopathy, so be careful of that when choosing a diagnosis. ICD-10-CM now includes many combination codes which represent the definitive diagnosis as well as radiculopathy, a common symptom of the diagnosis.  For instance, you won’t report M54.13 when you’re reporting any code from the M50.1 category (Cervical disc disorder with radiculopathy). The “with” term in the ICD-10-CM descriptor indicates that the radiculopathy is “associated with,” caused by,” or “due to” the definitive diagnosis.

Underneath the M54.1 (Radiculopathy) category, you have an Excludes1 note that forbids you from reporting any of these conditions with any of the following codes:

• neuralgia and neuritis NOS (M79.2)
• radiculopathy with cervical disc disorder (M50.1)
• radiculopathy with lumbar and other intervertebral disc disorders (M51.1-)
• radiculopathy with spondylosis (M47.2-).

Terminology refresher: Neuritis means a nerve inflammation or general inflammation of the peripheral nervous system, while radiculitis means the patient has pain radiating along the nerve paths due to inflammation of the spinal nerve roots. 

Similarly, when a patient as radiculopathy of the spine, this means that one or more of her nerves do not work properly. The emphasis of the problem is on the nerve root. This results in pain, weakness, numbness, or difficult controlling specific muscles.