Spinal Stenosis vs Foraminal Stenosis

michelleholt

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Hello,

My question is if a provider is stating lumbar stenosis and foraminal stenosis M48.06/M99.83, do you code them both or do you code to the more specific M99.83?

Thank you ahead of time for your help.
 

AlanPechacek

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Spinal &/or Foraminal Stenosis

The Code Set M99 is for Biomechanics Lesions, NEC, which does cover various spinal stenosis situations, but comes with the Coding Note that "This category should not be used if the condition can be classified elsewhere." That mean that these should be used only when there is no other "specific" diagnosable cause or disease that explains the stenosis. These would be "last resort" codes for spinal stenotic conditions. For practical purposes, in Orthopedic or Neurosurgical Spine practices, there is going to be an identifiable cause. The term "stenosis" simply means an anatomic "narrowing" of the spinal canal or foramen. Either or both are smaller than they should be, and this "shrinkage" causes crowding resulting in pressure on the spinal cord or nerve. Spinal Canal &/or Foramina Stenosis can result from various vertebral, disc, facet joint, or other "soft tissue" disorders of the spine, singularly or in combination. The most likely are from the variety of degenerative spine disorders, and are generally going to be in the Spondylopathies (M45-M49 Codes) &/or Other Dorsopathies (M50-M54). In the Spondylosis category (M47. _ _) are the effects of Degenerative Arthritis of the Spine (which is what Spondylosis is) with M47.1 _ for that with myelopathy (damage from pressure on the spinal cord, i.e. canal stenosis) and M47.2 _for that with radiculopathy (nerve root damage from pressure while it is still in the spinal canal &/or in the foramen as it leaves the spine). Then there is M47.81 _: "Other" Spondylosis without Myelopathy and/or Radiculopathy. Spinal and Foraminal Stenosis can occur without cord or nerve damage. M48.0 _ is for "Other" Spondylopathies such as and including Spinal and Caudal Stenosis. This seems to be fairly "generalized" for this topic, but not very specific, and I would consider it to be a "generic" code, and not one I would recommending be used alone. I would supplement it with other codes that are more specific.

In the Other Dorsopathies are Disc Disorders of the spine, M50 for the Cervical Spine and M51 for the rest of the Spine, and covering with myelopathy &/or radiculopathy, disc displacement (which covers ruptured, herniated, extruded, &/or protruded discs), degenerated disc, and "other" disc disorders, as delineated by the 4th Characters.

These Code Sets would be where to find codes for Chronic situations that could cause or result in stenosis of the canal &/or foramen.

For Acute and Traumatic causes, these would be in the S Codes, and could result from any number of boney/vertebral and/or discal injuries. For Acute Disc Ruptures, S13.0XX _ covers the Cervical Spine; S23.0XX _ the Thoracic; and S33.0XX _ the Lumbar Spine regions. Any other associated spinal injuries would also have to be identified and coded.

This is a much more extensive discussion of Spinal Stenosis problems than you might have been expecting, but it is a very complex subject and can't be explained simply. I would recommend visiting the website icd10orthocoder.com, view what is there, and in particular the Blogs where there are lengthy discussions of coding for spinal pain and problems. The information there may be helpful to you.

Respectfully submitted, Alan Pechacek, M.D. (icd10orthocoder.com)
 

jeskla

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recently audited

We recently went through and audit, and I used M99.7X for foraminal stenosis. Each was counted wrong, referencing what the good doc said above. " This category should not be used if the condition can be classified elsewhere." My auditor suggested I go with the M48. series for central and foraminal stenosis.
 

Teri

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This was a dillemma for me also

:confused::confused:

Hello,

My question is if a provider is stating lumbar stenosis and foraminal stenosis M48.06/M99.83, do you code them both or do you code to the more specific M99.83?

Thank you ahead of time for your help.

I was just coding one of those reports for a patient who is in the emergency room. I code both. They are two different caterories even tho the same area. Adding both adds specificity. Later on, someone may decide there is no foraminal stenosis and move on, but maybe they need to look at the lumbar stenosis at that point. Having both is worse.

I hope this is some help.
 
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