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Radiology Coding Alert

Reader Question:

Reporting Myelopathy

Published on Fri Mar 01, 2002

Question: I have several reports from MRIs of the cervical and lumbar spine with impressions that contain language like ... moderate-sized left paracentral disc protrusion at the T12-L1, causing impression upon the left aspect of the thecal sac. It does not extend into the neural foramen. Another example is, ... causing impression on the left aspect of the thecal sac with mild compromise of the neural foramen. I am unsure when to code a disc disorder with myelopathy (722.7x) or without myelopathy (722.0 or 722.1x). Can you help? At what point is it considered myelopathy?

Ohio Subscriber
 
Answer: The simplest definition of myelopathy indicates that the condition suggests spinal cord involvement. The Ohio Medicare carriers LMRP, for instance, states that For purposes of this policy, myelopathy or radiculopathy refers to signs and symptoms suggestive of sensory or motor dysfunction that could be attributed to specific spinal cord or nerve root disorders. Similarly, the definition for myelopathy in Tabers Medical Dictionary is, Any pathological condition of the spinal cord. Further, pathology is defined as a condition produced by disease or study of the nature and cause of disease which involves changes in structure and function. Therefore, myelopathy relates to abnormal structure and function of the spinal cord.
 
Assign a code from the 722.7x series (e.g., 722.72, Intervertebral disc disorder with myelopathy, thoracic region), for instance, if the disc disorder or herniation is causing spinal cord impingement. Other impingements might be more appropriately indicated with a code from 722.0-722.1x (e.g., 722.10, Displacement of thoracic or lumbar intervertebral disc without myelopathy, lumbar intervertebral disc without myelopathy). Based on these guidelines, the first example above would most likely not be assigned a myelopathy code. However, the second example indicates spinal cord compromise and, therefore, a myelopathy code may be appropriate.
 
Note: Experts advise coders to assign a code stating with myelopathy only when the physician describes the condition as such.

  Reader Questions and You Be the Coder were answered and reviewed by Donna Richmond, RCC, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., that serves more than 200 radiologists, pathologists and anesthesiologists.

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