As people age, their body undergoes several changes. In certain cases, parts of the body may wear down even without a direct instance of injury, leading to severe structural changes that cause pain. Several degenerative disorders may impact the cervical spine. Cervical Myelopathy is one such disorder that causes compression of the spinal cord in the cervical spine (neck) characterized by clumsiness in the hands and gait imbalance. Cervical spine comprises seven vertebrae (C1 to C7) – with six inter-vertebral discs and eight nerve roots. Any space-occupying injury within the cervical spine that can cause compression can lead to cervical myelopathy. Treatment for this condition may depend on the severity and type of injury and in most cases involves a combination of non-surgical and surgical techniques. Cervical specialists treating this spinal degenerative condition need to ensure that the billing and coding for this condition is properly done on the medical claims. Relying on the services of a reputable physician billing company can ensure accurate documentation and reimbursement.
There are different types of cervical myelopathy. One common type is cervical spondylotic myelopathy – which relates to the gradual degeneration of the spine that happens as people age. Therefore, this type of cervical myelopathy is more common in people aged 50 years and older. In fact, the gradual degeneration of the spine often takes different forms of cervical spinal stenosis. In some cases, people are born with a narrow spinal canal (congenital spinal stenosis) and may experience myelopathy sooner than others if further narrowing occurs. On the other hand, bulging or herniated discs and bone spurs in the neck are other forms of spinal degeneration that can put severe pressure on the spinal cord and cause myelopathy. Apart from the gradual wear and tear of the spine, cervical myelopathy can also be caused by the hardening of the ligaments surrounding the spinal cord (like posterior longitudinal ligament and ligamentum flavum). Other related causes of this condition include – spinal infections, spinal tumors and cancers, rheumatoid arthritis of the neck and whiplash injury or other cervical spine trauma.
What Are the Symptoms of Cervical Myelopathy?
Symptoms include neck pain, reduced range of motion, stiffness in the neck, weakness, numbness or tingling in the arms and hands, and balance issues. The signs and symptoms may develop slowly. Due to the lack of pain, there may be a large interval of time between the onset of the disease and the first treatment. Some of the early symptoms include –
- Loss of dexterity
- Atrophy of the muscles
- Difficulty in fine finger movements
- Weakness in the arms and hands
- Numbness or tingling in the arms and hands
- Clumsiness and poor coordination of the hands
- Difficulty handling small objects, like pens or coins
- Loss of strength and balance issues
- Increased reflexes in the lower extremities and in the upper extremities below the level of the lesion.
However, as the condition progresses, patients may experience a shooting pain that originates in the neck and travels down the spine. Even though many people experience neck pain, not all neck pain can be traced back to cervical myelopathy. In certain other cases, patients with this condition do not have any neck pain at all. At a later stage, symptoms like upper extremity numbness and gait disturbance may also occur and some individuals may even become wheelchair dependent.
Diagnosing and Treating Cervical Myelopathy
An early symptom associated with cervical myelopathy being loss of dexterity – the condition is often mistaken as a normal sign of aging. However, the earlier the condition gets diagnosed, the better will be the prospects of more successful treatment. Diagnosis of this condition may begin with a physical examination to measure the muscle strength and reflexes in a detailed manner. Several imaging tests like – MRI scan, X-ray or a CT myelogram of the neck may be performed. In addition, nerve conduction studies may be performed to measure how well the nerves in the arms and hands communicate with the brain through the spinal cord.
As mentioned above, the treatment for this condition involves a combination of non-surgical and surgical techniques. Mild cases of cervical myelopathy may only require conservative treatment to reduce symptoms. Non-surgical treatment includes physical therapy (focused on strengthening and stretching the neck), prescription medications and using a soft, cushioned cervical collar (that wraps around the neck and limits neck motion) for a specific period of time. However, if conservative treatment methods fail to provide relief, a spine specialist will determine if a surgical procedure can address structural problems in order to improve pain. The decision or choice of surgical procedure will vary depending on the patient’s specific symptoms and where exactly the spinal cord is compressed. Common surgical procedures include – laminoplasty (involves widening of the spinal canal) and spinal fusion surgery (to stabilize the spine).
Billing and coding involve using the specific ICD-10 diagnosis codes to report cervical myelopathy on the medical claims that providers submit to health insurers. ICD-10 diagnosis codes for cervical myelopathy include –
- M50 Cervical disc disorders
- M50.0 Cervical disc disorder with myelopathy
- M50.00 Cervical disc disorder with myelopathy, unspecified cervical region
- M50.01 Cervical disc disorder with myelopathy, high cervical region
- M50.02 Cervical disc disorder with myelopathy, mid-cervical region
- M50.020 Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
- M50.021 Cervical disc disorder at C4-C5 level with myelopathy
- M50.022 Cervical disc disorder at C5-C6 level with myelopathy
- M50.023 Cervical disc disorder at C6-C7 level with myelopathy
- M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
As the early signs and symptoms of cervical myelopathy may often resemble or be mistaken as a normal sign of aging, it is important for patients to never self-diagnose the condition. Self-diagnosing or experimenting with different treatment methods or home remedies is not recommended as this may worsen the condition. A professional spine specialist can correctly guide a patient with a clear diagnosis and thorough details about their cervical condition.
Medical billing and coding for different types of cervical myelopathy can be complex. With outsourced medical billing services from a reliable medical billing and coding company, healthcare practices can ensure correct and timely medical billing and claims submission.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.