"L. spondylosis without radiculopathy" and "L. radiculopathy" coded together?

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"L. spondylosis without radiculopathy" and "L. radiculopathy" coded together?

I do outpatient coding for a pain center and recently they've realized that certain procedures aren't being covered if the diagnosis includes "...spondylosis with radiculopathy." So the doctor has begun listing the diagnoses in those patients who have spondylosis with radiculopathy in their entire histories (who were being coded as M4726) as having "lumbar spondylosis without myelopathy or radiculopathy" (M47816) and "lumbar radiculopathy" (M5416) now in order to try to get paid for the procedures. I have not coded these charts because I feel that M47816 is fraudulent, but the doctor has stated that they are not mutually exclusive codes and that a person can have radiculopathy unrelated to spondylosis. I've been researching it quite a bit and can't seem to find a definite answer. Should I code them both or keep holding them? Can both codes be accurate?
 

ocook

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L. spondylosis without radiculopathy" and "L. radiculopathy" coded together??

Did you ever get an answer to your thread question of billing L. spondylosis without radiculopathy" and "L. radiculopathy" coded together?
 

mitchellde

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it will depend on the documentation as to how it is coded by the coder. Radiculopathy is automatically causal to the spondylosis. Look in the code book under spondylosis then you see 'with', and under with, is radiculopathy. By coding guidelines this is to be coded as automatically causal using the combined code. If the provider does not feel the radiculopathy is causal to the spondylosis then the provider must document specifically that the two conditions are unrelated. Remember we code from documentation not from the providers selected code.
 
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