Pain Management Coding Alert

Published on Tue Jun 02, 2015 PDF

Heads up: Get ready for more choices with ICD-10.

“Schmorl’s nodes” might not be a term you hear every day, but it’s actually a condition that affects about 30 percent of the population. ICD-9 includes several diagnosis codes for Schmorl’s nodes – protrusions of disc material into the adjacent vertebral bone – based on the spinal location, and ICD-10 will be the same. 

A Schmorl’s node (also called a Schmorl’s nodule) is typically found in the thoracic or lumbar spine (mid or lower back). Your current diagnosis choices are: 

• 722.31 (Schmorl’s nodes of thoracic region)  

• 722.32 (Schmorl’s nodes of lumbar region) 

• 722.39 (Schmorl’s nodes of other spinal region)

• 722.30 (Schmorl’s nodes of unspecified region). 

ICD-10 changes: You’ll have a few more options when you begin coding with ICD-10, which will help your physician assign an even more accurate diagnosis. They will include: 

• M51.44 (Schmorl’s nodes, thoracic region) 

• M51.45 (Schmorl’s nodes, thoracolumbar region) 

• M51.46 (Schmorl’s nodes, lumbar region) 

• M51.47 (Schmorl’s nodes, lumbosacral region).  

If your physician documents the Schmorl’s node in any other part of the vertebral column, you’ll often turn to M51.9 (Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder). Another option will be M53.3 (Sacrococcygeal disorders, not elsewhere classified). If your physician does not specify where the Schmorl’s node was located in the vertebral column, query him or her for the anatomic location. If you still aren’t able to get the information, you’ll again report M51.9.  

Background understanding: Schmorl’s nodes are upward or downward vertical protrusions of the intervertebral disc’s soft tissue nucleus, into the bony endplate of an adjacent vertebral body. They’re most commonly found incidentally when investigating back pain, sciatica, or some other cause and usually are not related to pain. However, a small percentage of patients with Schmorl’s nodes will have back pain that doesn’t respond to typical therapies. An MRI often will show bone swelling surrounding the Schmorl’s node. Vertebroplasty may be an effective way to treat these patients, especially those with osteoporosis.