Radiology Coding Alert

Question: Which ICD-9 Codes should I report for a herniated disc?

Delaware Subscriber

Answer: If your only diagnosis is "herniated disc,"your coding choice is 722.2 (Displacement of intervertebral disc, site unspecified, without myelopathy). But the radiologist should designate the location. With that detail, the more appropriate code could range from 722.0 (Displacement of cervical intervertebral disc without myelopathy) for cervical disc problems to 722.1x (Displacement of thoracic or lumbar intervertebral disc without myelopathy) for lumbar or thoracic conditions to one of the many choices from 839.xx (Other, multiple and ill-defined dislocations) for injury-induced dislocation or herniation.

Tip: Disc herniation doesn't usually happen overnight;the discs go through several stages before reaching that point. The more you know about the stages of herniation and the more specific the physician's diagnosis is, the more detailed your coding can be. When a disc herniates or ruptures, the nucleus comes out through a tear in the annulus (outer ring of fibers) and can compress a nerve root. This can happen on either side of the disc or on both sides. Look for terms such as degeneration, prolapse, extrusion, and sequestration that differentiate the various stages of disc herniation

Look ahead: When ICD-10 goes into effect in 2013, your code will begin with a letter and will match to a precise anatomic location. For example, ICD-10-CM 2010 (www.cdc.gov/nchs/icd/icd10cm.htm#10update, Tabular List) includes cervical disc displacement under codes such as the following:

• 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.