ICD-9 Medical Coding: Learn How A Few Letters Can Make a Huge Difference to Your Code Choices


Spondylosis vs. spondylolysis vs. spondylolisthesis and myelopathy vs. myopathy

Many of our ICD-9 codes are based on spinal regions. There are different ICD-9 codes based on the spinal region. Read this expert medical coding article for more.

We have different spinal regions. Cervical region, there's seven vertebrae in that upper neck area. We have 12 vertebrae in the thoracic region. They correspond to each of our ribs. We have five vertebrae in that low back, lumbar region. We have the sacrum region that’s actually four vertebrae. They're fused to form one bone. There's not any separate bone there. And last but not least, we have our (coxics), the very lower in part of our spine.

Well, looking at when you come across a term that you're not familiar with, the best steps are to break it down into prefixes, suffixes but also the root. So the root of many of our pain management conditions regarding our spine is spondyla. SPONDY. And what that means is vertebrae or joint of a vertebrae.

As stated by our expert in a medical coding conference, Spondyla is the basis of vertebrae of joints of vertebrae. So when we add the suffix on, OSIS spondylosis. Osis just means an abnormal process. Well, spondylosis is really a degenerative disorder characterized by degenerative deformity of the spine.

Typically the wear and tear, this is very similar to our degenerative joint disease if we just use a different term in our spine. Instead of like our knees, we called it degenerative joint disease of the knee or osteoarthritis of the knee. It may be also be spondylosis is of the spine.

So other descriptors in that inclusion would be arthritis, osteoarthritis, spondyla arthritis. Our providers sometimes use the term facet arthroscopy. That's often used interchangeably with spondylosis. If you step yourself through the volume 2 that alphabetic index, there is no listing for spinal under facet under arthritis or arthropathy. So it directs you to see also arthritis. And if you look at arthritis spine, it's going to direct you to spondylosis code so you would compliant for say lumbar facet arthropathy to use the lumbar spondylosis ICD-9 code.

We have three different for the specific spinal regions of lumbar cervical thoracic and lumbar sacral spondylosis without myelopathy.

In contrast, that 721.90 is unspecified as per the medical coding guidelines. Providers must get away from that habit of not specifying. It can lead to claims denials due to lack of medical necessity, lack of specificity.

Well spondylosis is very common and occurs with aging. More than 80% of individuals or older than 40 years have lumbar spondylosis. However, of that 80%, only barely 27% to 37%, a third of them are asymptomatic.

So just because we have an MRI or a CT or an x-ray that says the patient has spondylosis, that may not be the source of the patient’s pain. So we need to be cautious just grabbing things off of diagnostic studies and reporting them as the reason for procedures.

Myelopathy: MYEL is the root of spinal cord. Opathy is an abnormality. It describes any functional disturbance of the spinal cord itself. It's means like a six spinal cord or disease of the spinal cord. It affects the entire spinal cord. So not only do we have pressure on sensory fibers but we also have pressure on the motor fibers. And so, that's why it's typically detected.

Difficulty walking, our thigh muscles, our big quadriceps and hamstrings don’t work potentially. And so, they have generalized weakness problem with balance and coordination.

We want to contrast the difference between myelopathy and myopathy. Myopathy is a disorder of muscles. And so, it's difference in the root. And it's important for us to understand the difference because we have a cervical thoracic and lumbar sacral spondylosis with myelopathy.

Unfortunately in pain management medical coding, and many providers don’t document that term myelopathy. And so, we don’t get the chance to report this. It's maybe not that the patient doesn’t have the condition. They just don't use that term myelopathy. And so because of that term with, these are the only times that we can actually use it is when that term or there's been good documentation of the myelopathy.

Well, looking at spondyla, the next condition, olysis. Olysis just means there's a breakdown. Well, the parts in our articularis, that connects the part of that facet joint to the posterior part of the body. And so, it connects that the lamina or that posterior part to that vertebral body, the anterior part.

And so, when we have a defect in the parts into articularis, that means is there is some type of a fracture or a breakdown of those parts into articularis. If there is a fracture of the parts into articularis, this would be considered spondylolysis. Well, about 95% of cases of spondylolysis occur in the lumbar region. And so, we don’t have specific spondylolysis codes for all of them. It can be unilateral of bilateral.

We have two different diagnosis medical coding options so it's a clear understanding for what the causation of the spondylolysis. If it's congenital, then we're going to look in that congenital anomaly section of the ICD-9 book for 756.11. However, if it's acquired, the patient didn’t have it when they were born. That fracture or breakdown was not there when they were born. They acquired it due to degenerative issues or fractures.

It's the most common cause of low back pain. In adolescent, athletics really associated with gymnastics. Stress fracture of that parts into articularis. Then we're going to report 738.4.

Bilateral parts defect or bilateral spondylolysis can lead to spondylolisthesis. Olisthesis is the suffix means to slip or slide. And literally what that means is we've got one vertebrae slipping forward usually on an adjacent vertebrae. It usually occurs in that lumbar spine.

We can also have a Hangman’s fracture is a cervical spondylolisthesis due to the fractures of the C2 pedicles. If have if it's a congenital spondylolisthesis, we're going to report 756.12. In contrast, we're going to report that same diagnosis code no matter whether it's an acquired spondylolysis or a spondylolisthesis, it's 738.4 as per the medical coding guidelines. We don’t have a differentiation. That's one of the issues with ICD-9. It's the lack of specificity. And so, the type is based on that causation.

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