Coding, Classification & Reimbursement

1.  Supporting Dx for Spondylosis

Posted 10 days ago
Edited by Charissa Becker-Martinez 10 days ago

I meant "supporting Dx for Facet joint injections (CPT 64493)"...I code for pain management at our local hospital.  I am looking for feedback on how I've been coding spondylosis when the provider indicates, "...low axial back pain due to lumbar spondylosis".  For this Dx I have recently coded M47.9 (Spondylosis, unspecified)...and received a denial for payment using this code (commercial insurance, not Medicare).  The provider states that I should be submitting M47.896 (Other spondylosis, lumbar region) when he doesn't specify with/without myelopathy or radiculopathy.  I keep asking...what constitutes "OTHER" spondylosis in this situation, and what should I be looking for in the H&P??  Any input would be greatly appreciated!

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Charissa Becker-Martinez, CCS-P
Certified Coder/Abstractor
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2.  RE: Supporting Dx for Spondylosis

Posted 8 days ago
I usually use M47.816 for unspecified lumbar spondylosis. 😀

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Andrew Pearce
Outpatient Coding Specialist
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3.  RE: Supporting Dx for Spondylosis

Posted 8 days ago
Thank you for your reply Andrew.  I was doing this originally, but my provider informed me that "...I haven't made that decision yet of whether the patient has myelopathy or radiculopathy"...and have been second-guessing myself ever since.  I have been told by my supervisor that the simple statement lumbar spondylosis qualifies for "other".  I'm not convinced yet, and my research has turned up nothing I can run with.

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Charissa Becker-Martinez, CCS-P
Certified Coder/Abstractor
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4.  RE: Supporting Dx for Spondylosis

Posted 8 days ago
You're welcome! I use "other spondylosis" for facet hypertrophy of spine.

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Andrew Pearce
Outpatient Coding Specialist
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5.  RE: Supporting Dx for Spondylosis

Posted 8 days ago
  |   view attached
I don't have much to offer, because I couldn't find anything specific that would come under this other spondylosis in doing a web search on types of spondylosis and I suspect you tried the same.

However, I did look at the GEM mappings. Interestingly, these codes under M47.89  (the specified NEC per index) AND M47.81_ (without myelopathy/radiculopathy) categories all map back to the same ICD-9 codes of 721.0, 721.2, 721.3, and 721.90. These were cervical, thoracic, lumbosacral spondylopathy without myelopathy and spondylosis of unspecified site without mention of myelopathy. In ICD-9, radicopathy was coded separately by site only- so there were separate codes for lumbar radiculopathy, etc. only.

So, in ICD-9, spondylosis was indexed as either with or without myelopathy. There were no codes for spondylosis with or without radiculopathy. You'd just code the radiculopathy separately.

It's confusing.  Based on this, it would seem you could use either category of codes. Some clarification on this may be helpful from the powers that be. But because the site is specified, I would not use the unspecified code.

For your reference, I've attached the 2018 GEM file in txt format, but it . You can just press control F and search from that box. Or just Google search for 2018 GEM if this doesn't work.

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Jodi Kingley, CCS
Inpatient Coder
Princeton HealthCare System
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Attachment(s)

txt
2018_I10gem.txt   1.63MB 1 version


6.  RE: Supporting Dx for Spondylosis

Posted 8 days ago
Thank you both Andrew & Jodi!  I see the term "Facet Hypertrophy" often, so this is good piece of information...something I can run with!  It is curious that the ICD-9 codes map to M47.81- (never would have thought of checking that out!).  Secondly, your response (Jodi) makes it clear that a better understanding from the powers-that-be might be warranted for the code ranges under M47.81- and M47.89-.  I appreciate your thoughts very much!

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Charissa Becker-Martinez, CCS-P
Certified Coder/Abstractor
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7.  RE: Supporting Dx for Spondylosis

Posted 7 days ago
Good point about the facet hypertrophy.

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Jodi Kingley, CCS
Inpatient Coder
Princeton HealthCare System
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8.  RE: Supporting Dx for Spondylosis

Posted 7 days ago
Yeah, I seem to see the same diagnoses on radiology accounts over and over again. I see foraminal stenosis, facet arthropathy and bunch of others! Let me know if I can be of any assistance🤓

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Andrew Pearce
Outpatient Coding Specialist
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