Regarded as one of the most complex structures in the human body, the spine supports the head and the spinal cord. The spine consists of 26 bones called vertebrae, which protect and support the spinal cord and the nerves. A number of conditions and injuries can damage the vertebrae, causing spinal pain and limiting mobility. Pain occurs when bone changes put considerable pressure on the spinal cord or nerves. Treatments for acute back pain include braces, medications (such as anti-inflammatories, pain relievers, or muscle relaxers), Injections (like corticosteroids or nerve blocks) and rehabilitation techniques (like physical therapy exercises to strengthen and stretch the back and abdominal muscles). Surgery to replace discs, fuse (connect) vertebrae, open up the spinal canal, or repair nerves will be considered if the condition does not resolve with non-operative treatments. Physicians’ practices need to use the correct ICD-10 codes to report spinal disorders. Relying on the services of an established orthopedics medical coding company can help in accurate and timely claim submission for appropriate reimbursement.
Symptoms of Spine Disorders
The signs and symptoms of spine conditions will depend on the type and the area of the spine or spinal cord that get affected. Common symptoms include –
- Abnormally rounded shoulders or back
- Weakness, numbness, or tingling in the arms or legs
- Uneven appearance, such as one shoulder or hip being higher than the other
- Stiffness or tightness
- Sharp or stabbing back or neck pain
- Pain radiating in the arms or legs
- Nausea and/or vomiting
- Bladder or bowel dysfunction
ICD-10 Codes
Let’s take a look at the ICD-10 codes for five common spine conditions –
Sciatica – Sciatica is chronic pain caused by the compression or irritation of the sciatic nerve. Usually, the pain starts in the lower back and extends through the hip and buttock down one leg. One of the most common causes for low back and leg pain, sciatica primarily affects people between the ages of 30 and 50. The condition generally affects only one leg and may get worse when you sit, cough or sneeze. Common symptoms include – numbness in the leg along the nerve, tingling sensations in the feet and toes, debilitating pain, and cramping and weakness in the muscles of the involved leg. ICD-10 codes for sciatica are –
- M54.3 – Sciatica
- M54.30 – Sciatica, unspecified side
- M54.31 – Sciatica, right side
- M54.32 – Sciatica, left side
Scoliosis – A common spine disorder, scoliosis causes the spine or backbone to curve sideways. The condition can affect any part of the spine, but the most common regions are the chest area in the thoracic and thoracic-lumbar regions (that occur mainly due to congenital or degenerative problems). The condition is typically seen in children aged between 10-12 years and is more common in girls than in boys. Scoliosis is categorized into five types namely – Congenital scoliosis, Adolescent idiopathic scoliosis, Degenerative scoliosis, neuromuscular scoliosis and Syndromic scoliosis. Symptoms of this spinal condition include – uneven shoulders, one shoulder blade that appears more prominent than the other, uneven waist, and one hip higher than the other. Related ICD-10 codes include –
- M41 – Scoliosis
- M41.0 – Infantile idiopathic scoliosis
- M41.1 – Juvenile and adolescent idiopathic scoliosis
- M41.12 – Adolescent scoliosis
- M41.2 – Other idiopathic scoliosis
- M41.3 – Thoracogenic scoliosis
- M41.4 – Neuromuscular scoliosis
- M41.5 – Other secondary scoliosis
- M41.8 – Other forms of scoliosis
- M41.9 – Scoliosis, unspecified
Ankylosing spondylitis (AS) – Ankylosing spondylitis (AS) is a form of arthritis that primarily affects the spine. The condition causes inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort. Typically, AS tends to first develop in teenagers and young adults. It is around 2 times more common in men than in women. Symptoms of AS include – back pain and stiffness, pain and swelling in other parts of the body and extreme tiredness (fatigue). In most cases, these symptoms tend to develop gradually, usually over several months or years, and may come and go over time. Related ICD-10 codes include –
- M45 – Ankylosing spondylitis
- M45.0 – Ankylosing spondylitis of multiple sites in spine
- M45.2 – Ankylosing spondylitis of cervical region
- M45.3 – Ankylosing spondylitis of cervicothoracic region
- M45.4 – Ankylosing spondylitis of thoracic region
- M45.5 – Ankylosing spondylitis of thoracolumbar region
- M45.6 – Ankylosing spondylitis lumbar region
- M45.7 – Ankylosing spondylitis of lumbosacral region
- M45.8 – Ankylosing spondylitis sacral and sacrococcygeal region
- M45.9 – Ankylosing spondylitis of unspecified sites in spine
Kyphosis – Kyphosis is a spinal condition that causes an excessive outward curve of the spine resulting in an abnormal rounding of the upper back. Also known as “hunchback”, the condition can occur at any age, but is more common during adolescence. Mild kyphosis may produce no noticeable signs and symptoms. On the other hand, severe kyphosis can cause chronic pain and be disfiguring. Treatment for the condition depends on patient age, and the cause and effects of the curvature. The ICD-10 codes for kyphosis are –
- M40 – Kyphosis and lordosis
- M40.0 – Postural kyphosis
- M40.00 – Postural kyphosis, site unspecified
- M40.03 – Postural kyphosis, cervicothoracic region
- M40.04 – Postural kyphosis, thoracic region
- M40.05 – Postural kyphosis, thoracolumbar region
- M40.1 – Other secondary kyphosis
- M40.10 – Other secondary kyphosis, site unspecified
- M40.12 – Other secondary kyphosis, cervical region
- M40.13 – Other secondary kyphosis, cervicothoracic region
- M40.14 – Other secondary kyphosis, thoracic region
- M40.15 – Other secondary kyphosis, thoracolumbar region
- M40.2 – Other and unspecified kyphosis
- M40.20 – Unspecified kyphosis
- M40.202 – Unspecified kyphosis, cervical region
- M40.203 – Unspecified kyphosis, cervicothoracic region
- M40.204 – Unspecified kyphosis, thoracic region
- M40.205 – Unspecified kyphosis, thoracolumbar region
- M40.209 – Unspecified kyphosis, site unspecified
- M40.29 – Other kyphosis
- M40.292 – Other kyphosis, cervical region
- M40.293 – Other kyphosis, cervicothoracic region
- M40.294 – Other kyphosis, thoracic region
- M40.295 – Other kyphosis, thoracolumbar region
- M40.299 – Other kyphosis, site unspecified
Spondylosis – Spondolysis is a degenerative condition of spine that causes structural changes in any part of the spine including the bones, spinal joints, vertebrae or the cartilage disc. The condition can occur in any part of the spine including the cervical spine (neck), thoracic spine (upper and mid back), or lumbar spine (low back). Symptoms include – back pain, stiffness, pain on movement, regional tenderness and muscle spasm. For reimbursement purposes, report the following codes –
- M47 – Spondylosis
- M47.0 – Anterior spinal and vertebral artery compression syndromes
- M47.1 – Other spondylosis with myelopathy
- M47.2 – Other spondylosis with radiculopathy
- M47.8 – Other spondylosis
- M47.81 – Spondylosis without myelopathy or radiculopathy
- M47.89 – Other spondylosis
- M47.9 – Spondylosis, unspecified
The spinal cord is one of the most complex structures in the human body. Even the slightest change in the structure of the spine can cause severe damage, pain and disability. Reports from the National Spinal Cord Injury Association suggest that about 450,000 people (2015 statistics) in the United States are living with some kind of spinal cord related condition or injury. Living with a spinal disease can make daily life very challenging at times.
Knowing the highly specific ICD-10 codes related to documenting spine conditions is critical for healthcare providers. The support of an experienced medical billing and coding company can be very valuable when it comes to ensuring timely and accurate claims submission for optimal reimbursement.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.