This is a situation where the doctor would have to be made aware that if the radiculopathy is "attributable to the herniated disc" that he needs to describe in the Dx section as for example
Radiculopathy due to lumbar disc protrusion
If the physician is not aware of the coding options with this he probally will continue to not state the relation of the symptom and the condition. I think you could query the physician but by going by the 1994 AHA Coding Clinic example it sounds it there is not a correlation made you could potentially bill both 722.10 and 724.4.
As seen below it states in the AHA Coding Clinic in 1994
".......Lumbar spinal stenosis, since the physician has stated that the lumbar stenosis is not attributable to the herniated disc."
This is a clarification of the information that was previously published inCoding Clinic, Second Quarter 1989,p. 14.
_____________________________________________________________________
Volume: 1989
Issue: Second
Title: Excludes notes under
diagnosis codes 723 and 724
Body: Question:
Please clarify the"Excludes" notes under 723 and 724.Do these "Excludes" notes mean that conditions due to intervertebral disc disorders or spondylosis are included in codes 721.0--722.9 or do both conditions need to be coded?
Answer:
Symptoms and signs associated with (due to) spondylosis and allied disorders, 721.0--721.91, or intervertebral disc disorders (such as slipped disc or arthritic degeneration of intervertebral disc), 722.0--722.93, are included in the 721--722 code series.
Examples
• Sciatica, 724.3, due to a slipped or degenerative intervertebral disc is included in the 722 category.
• Pain or neuritis due to spondylosis or intervertebral disc disorder is included in the 721--722 categories.
• Spinal stenosis due to degeneration (arthritic) of the intervertebral disc is classified to the 722 category, while spinal stenosis, congenital or NOS, is classified within the 723--724 categories.
________________________________________________________________________
Volume: 1994
Issue: Third
Title: Clarification - excludes notes under categories 723/724
Body: Clarification of Excludes Notes under categories 723 and 724
Question:
A patient is admitted for surgical therapy because of chronic low back pain, which is presumed secondary to herniated intervertebral disc. A lumbar myelogram reveals lumbar disc herniation without myelopathy and lumbar spinal stenosis. The physician is queried and states, "The lumbar spinal stenosis is due to bony impingement." However, the physician denies the presence of spondylosis and cannot determine whether the spinal stenosis is congenital or acquired. Since the lumbar spinal stenosis is not attributable to the herniated disc, although it is an associated finding, is it appropriate to assign two codes 722.10, Displacement of lumbar intervertebral disc without myelopathy, and 724.02, Lumbar spinal stenosis?
Answer:
Assign code 722.10, Displacement of lumbar inter-vertebral disc without myelopathy, and code 724.02, Lumbar spinal stenosis, since the physician has stated that the lumbar stenosis is not attributable to the herniated disc.
This is a clarification of the information that was previously published inCoding Clinic, Second Quarter 1989,p. 14.