Pain Management Coding Alert

Heads up: You’ll have lots more diagnosis choices in 2015.

Choosing your diagnosis code for radiculopathy will get site-specific when ICD-10 becomes effective in October 2015. Start educating your providers now to document which of the spinal regions was treated to ensure that you’re ready for expanded code options. 

Pay Attention to Spinal Regions

The spine is divided into five regions, with a total of 33 vertebrae. The vertebrae in the two lower regions (sacral and coccygeal) are fused together, but vertebrae in the rest are each separated by intervertebral spaces. 

Many different conditions can cause spinal nerves to become inflamed, compressed, or suffer a compromise in blood supply. This leads to a type of neuropathy in one or more spinal segments known as radiculopathy. 

Terminology check: Radiculitis is inflammation of a spinal nerve root, especially of the portion of the root that lies between the spinal cord and the spinal canal. Radiculopathy is defined as disease of the nerve roots, and radicular pain manifests along the pathway of a spinal nerve.

Get Specific Documentation for Code Switches

ICD-9 includes two codes for radiculopathy: 

• 723.4 (Brachial neuritis or radiculitis, NOS), which you report for cervical radiculopathy 
• 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified), which you report for thoracic, lumbar, or sacral radiculopathy.

Having only have two diagnosis choices means that providers currently might not specify many anatomic-specific details in their documentation. That will change with ICD-10, when each of the two current codes will expand to multiple options. 

Cervical changes: Instead of having a single diagnosis code for cervical radiculopathy, you’ll have one code specifically for C0-C1 and C1-C2 (M54.11, Radiculopathy, occipito-atlanto-axial region), one code for cervical (M54.12, Radiculopathy, cervical region) and another for cervicothoracic (M54.13, Radiculopathy, cervicothoracic region). If your physician documents cervical disc disorder (such as intervertebral disc displacement, degeneration, or disease) with radiculopathy, you’ll have even more choices: 

• M50.10 – Cervical disc disorder with radiculopathy, unspecified cervical region 
• M50.11 – … occipito-atlanto-axial region 
• M50.12 – … mid-cervical region 
• M50.13 – … cervicothoracic region. 

Thoracic/Lumbar/Sacral changes: Diagnosis 724.4 gets more specific under ICD-10 with individual codes for spinal regions. Your basic code choices will be: 

• M54.14 – Radiculopathy, thoracic region
• M54.15 – … thoracolumbar region
• M54.16 – … lumbar region
• M54.17 – … lumbosacral region
• M54.18 - …sacral and sacrococcygeal region.

Again, you’ll have additional choices for intervertebral disc disorders with radiculopathy, distinguished by anatomic site: 

• M51.14 – Intervertebral disc disorders with radiculopathy, thoracic region 
• M51.15 – … thoracolumbar region 
• M51.16 – … lumbar region 
• M51.17 – … lumbosacral region. 

Note: Even with the extra choices, you won’t have a specific code under ICD-10 for intervertebral disc disorder with radiculopathy in the sacral and sacrococcygeal region. The L5-S1 intervertebral level will be the lowest level with a disc.