Wiki M54.16 billed with M47.816

[dtweedy]

Can M54.16 - lumbar radiculopathy be billed with M47.816 or M47.817 - other spondylosis lumbar without radiculopathy/ other spondylosis lumbosacral without radiculopathy. To me this is contradictory. I was coding/billing with M47.26 or m47.27 other spondylosis with radiculopathy lumbar and or lumbosacral region. Am I incorrect with my logic?

Thanks
Deb

 

[thomas7331]

It would be contradictory to use these two codes together to describe the same condition. But theoretically, both of these codes might be used in a case where documentation describes two distinct conditions - i.e. a form of spondylosis which is not causing radiculopathy, together with radical symptoms that the provider is attributing to some other cause, or perhaps an unknown cause which the provider states is not due to the spondylosis. I think it's unlikely that you'd see this situation and most likely it would be an error to see these together, however, it's not prohibited by any coding guidelines that I'm aware of.

 

[OpenClaims]

I have often seen providers document these separately, in that case I code them separately. If it is listed all together as one diagnosis, then I wouldn't do them separately. They are okay to be coded together, so I don't see you getting a denial for this either way.