Pain Management Coding Alert

Published on Mon Dec 29, 2014 PDF

Hint: Your coding will all depend on spinal regions.

When you transition to ICD-10, you’ll adopt more specific codes for intervertebral disc disorders because there will be new codes for disorders at the junction of two regions (such as cervicothoracic, thoracolumbar, and lumbosacral). Read on to prepare for what ICD-10 has in store.

Check Levels for Cervical Displacement

To report displacement of cervical intervertebral disc, you currently submit ICD-9 code 722.0 (Displacement of cervical intervertebral disc without myelopathy). ICD-10 will allow you to specify the precise location of the displacement (high or mid cervical), or displacement at the cervicothoracic region. Your code options will include M50.21 (Other cervical disc displacement, high cervical region), M50.22 (Other cervical disc displacement, mid-cervical region), and M50.23 (Other cervical disc displacement, cervicothoracic region). 

Alternative: If your physician doesn’t specify the cervical region of the displacement, you’ll report ICD-10 code M50.20 (Other cervical disc displacement, unspecified cervical region).

Get Specific for Thoracic and Lumbar Displacement

When your physician documents a diagnosis of lumbar intervertebral disc displacement, your current option is 722.10 (Displacement of lumbar intervertebral disc without myelopathy). This code will map to two ICD-10 codes: M51.26 (Other intervertebral disc displacement, lumbar region) for displacement in the lumbar region and M51.27 (Other intervertebral disc displacement, lumbosacral region) for displacement in the lumbosacral region.

“This would seem only to apply to an L5S1 disc displacement, but it is unclear the rationale to separately identify disc displacements at this single location,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, in Edison.

For displacement of the thoracic intervertebral disc, you report ICD-9 code 722.11 (Displacement of thoracic intervertebral disc without myelopathy). The corresponding ICD-10 codes are M51.24 (Other intervertebral disc displacement, thoracic region) and M51.25 (Other intervertebral disc displacement, thoracolumbar region).

ICD-10 difference: The ICD-10 codes for displacement in the thoracic and lumbar regions are more location specific. There are codes that you can submit for displacements at the junction of two regions, i.e. M51.25 for displacement at the thoracolumbar region and M51.27 for that in the lumbosacral region. 

If your physician doesn’t specify the thoracic or lumbar displacement location, you should report ICD-9 code 722.2 (Displacement of intervertebral disc site unspecified without myelopathy). The updated version in ICD-10 will be M51.9 (Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder).

Dig Deep Into Regions for Disc Degeneration

For cervical intervertebral disc degeneration (rather than displacement), you report a single ICD-9 code: 722.4 (Degeneration of cervical intervertebral disc). However, in ICD-10, you’ll have specific options for high, mid, and low cervical regions. You’ll choose from these codes in ICD-10. depending upon which part of the cervical region is affected:

• M50.31 – Other cervical disc degeneration, high cervical region
  
• M50.32 – Other cervical disc degeneration, mid-cervical region
  
• M50.33 – Other cervical disc degeneration, cervicothoracic region
  
• M50.30 – Other cervical disc degeneration, unspecified cervical region.
  

If your physician diagnoses thoracic or lumbar intervertebral disc degeneration, you file code 722.51 (Degeneration of thoracic or thoracolumbar intervertebral disc). ICD-10 will include two specific codes for these regions: 

• M51.34 – Other intervertebral disc degeneration, thoracic region
  
• M51.35 – Other intervertebral disc degeneration, thoracolumbar region.
  

Similarly, the ICD-9 code 722.52 (Degeneration of lumbar or lumbosacral intervertebral disc) maps to codes M51.36 (Other intervertebral disc degeneration, lumbar region) and M51.37 (Other intervertebral disc degeneration, lumbosacral region) in ICD-10.