Perfect Your Coding Skills for Cervical Disc Disorders
Do you know the ins and outs of the M50.- code set? To master coding cervical disc disorders, coders need to understand spinal anatomy and the types of conditions that affect cervical discs. Six discs separate the seven cervical vertebrae (C1 to C7). These discs facilitate mobility and act as shock absorbers to protect the fragile spinal cord and nerves from stress. When a patient has a cervical disc disorder, it’s on you to choose the most specific code possible for the patient’s condition. Read on for guidance on how to navigate through ICD-10-CM while searching for diagnoses related to cervical disc disorders. Know What Comprises Cervical Disc Collagen fibers comprise the outer layer of each cervical disc. This layer, called the annulus fibrosus, seals in and protects the interior of the disc and contributes to spinal stability. The gelatinous contents of the core, called the nucleus pulposus, include water, proteoglycans, type II collagen fibers, and chondrocyte-like cells. The nucleus pulposus acts as a cushion to prevent bone-on-bone contact, and redistributes stress between the vertebrae to ensure even load distribution. Cervical discs need to be well-hydrated to function properly, but aging and trauma can affect a disc’s ability to remain hydrated and repair itself from wear and tear. Patients with cervical disc disorders may experience pain, stiffness, numbness, or tingling that can interfere with their ability to participate in daily activities. Know the Main Types of Cervical Disc Disorders Some of the most common cervical disc disorders include: There are two key terms that coders should know to correctly navigate the code set for cervical disc disorders: radiculopathy and myelopathy. Cervical radiculopathy, which is typically the result of stenosis or a herniated disc, refers to compression or irritation of nerve roots. Patients with cervical radiculopathy may experience pain, numbness, or weakness in their neck, arms, or hands. Cervical myelopathy is defined as compression of the spinal cord in the neck. Cervical myelopathy can develop for a variety of reasons, including degenerative disc disease, herniated discs, and bone spurs. Keep radiculopathy and myelopathy in mind when you reference the M50.- (Cervical disc disorders) code set in the ICD-10-CM code book. Learn How to Navigate the M50.- Code Set This ICD-10-CM code set includes the following codes for cervical disc disorders: Note that the M50.- code set is organized primarily by disorder type. Let’s look at an example to see how to choose the correct M50.- codes: Say a patient has a cervical disc disorder with myelopathy at the C5 to C6 level. Start with the codes that cover myelopathy, which are the M50.0- codes. From there, we know that the disorder affects the patient’s mid-cervical region, so that narrows the code down to the M50.02- (Cervical disc disorder with myelopathy, mid-cervical region) range. Finally, use the specific code for the C5 to C6 region, which is M50.022 (Cervical disc disorder at C5-C6 level with myelopathy). Clinicians do not always include the exact location or details of a patient’s cervical disc disorder in the medical record. Let’s look at an example with more ambiguity: Say a patient has a specified cervical disc disorder with neither myelopathy nor radiculopathy, and the disorder is not covered under the codes for cervical disc displacement (M50.2-) or cervical disc degeneration (M50.3-), such as a calcified disc. This means that the most relevant code is in the M50.8- set. For this example, let’s say again that the disorder is at the C5 to C6 level. Refer to M50.82 (Other cervical disc disorders, mid-cervical region), then select M50.822 (Other cervical disc disorders at C5-C6 level). Remember These Tips When You Apply One of the M50.- Codes Those examples are relatively easy to follow, but what happens when a patient’s diagnosis involves multiple levels of the cervical spine? The golden rule in this situation is to only code for the highest level listed in the medical record. So, if a patient has radiculopathy at the C5 to C6 level and the C6 to C7 level, use M50.122 (Cervical disc disorder at C5-C6 level with radiculopathy); do not include M50.123 (Cervical disc disorder at C6-C7 level with radiculopathy). Keep in mind that there are CPT® codes for X-rays and MRIs that often apply to cervical disc disorders. These codes include: Sometimes, providers do not specify what type of cervical disc disorder the patient has. In these instances, refer to M50.9- (Cervical disc disorder, unspecified) and select the most appropriate code depending on which region of the cervical spine the disorder involves. If the provider does not specify the region, use M50.90 (Cervical disc disorder, unspecified cervical region). Michelle Falci, BA, M Falci Communications LLC, Contributing Writer 
