Wiki RADICULOPATHY/OTHER SPONDYLOSIS WITH RADICULOPATHY

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dtweedy

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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
 
A couple of things to consider-
Is the M54.16 current condition/active or is it on a problem list? I ran into this many years ago coding for pain services they would add all diagnosis that they expect to use or used to the problem list we do not code from the problem list.
 
For the spondylosis per ICD-10 CM you have 3 categories Spondylosis with radiculopathy M47.2, with Myelopathy M47.1 or without both Myelopathy/Radiculopathy M47.8. Review official coding guidelines for "With" or "in" Ch 15. pg 4. ICD-10 CM 2022. what it says is when "with" is (under a main term or sub-term) presumes a casual relationship. That being said if the documentation supports lumbar w/ current radiculopathy (usually within the physical exam or HPI, ROS or assessment and plan states spondylosis with radiculopathy) than you would code M47.26 only. DO NOT CODE it based on radiculopathy pulled in a problem list or history list. Best to query the provider.
 
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