Wiki Diagnosis inconsistent with the procedure

62322: Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance.

M51.26: Other intervertebral disc displacement, lumbar region

Yeah, I'm stumped. I checked Noridian (our MAC) for coverage codes and M51.26 is definitely one of them (I find if it's good for Medicare, it's usually good for everyone else). Since there's only 31 or 32 diagnoses for this procedure that Noridian accepts, it's kind of hard to go wrong with it. See article here.

You may need to put a pain diagnosis first, so consider these, if warranted:

Does the patient have sciatica? M54.31 and M54.32 are both listed
Low back pain? M54.5
Postherpetic neuropathy? B02.23
Lumbar stenosis? M48.xxx
 
I would check the payers policy. They don't all have policies that cover the same diagnosis codes for the same procedure. For instance Aetna only allows the following for 62322:

ICD-10 codes covered if selection criteria are met:
M47.20 - M47.28Other spondylosis with radiculopathy
M50.10 - M50.13Cervical disc disorder with radiculopathy
M51.14 - M51.17Intervertebral disc disorders with radiculopathy
M53.0 - M53.1Cervicocranial -hyphen cervicobrachial syndrome
M53.81 - M53.83Other specified dorsopathies [cervical region]
M54.10 - M54.18Radiculopathy
M54.2Cervicalgia
M54.30 - M54.5Sciatica and lumbago
M54.6Pain in thoracic spine
M54.9Dorsalgia, unspecified

Where as our local MAC allows 57 different diagnosis codes.
 
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