October 19, 2017
Question:
I just received a claim denial because I used M48.06 (Spinal stenosis, lumbar region) as the diagnosis code. What’s the deal? I’ve been using this diagnosis code without a problem since ICD-10-CM started.
Answer:
Aha! There are new diagnosis codes for lumbar stenosis that were effective October 1, 2017. The code M48.06 is no longer a valid diagnosis code. Instead, you’ll need to
report one of the following 2 diagnosis codes:
M48.061, Spinal stenosis, lumbar region without neurogenic claudication
M48.062, Spinal stenosis, lumbar region with neurogenic claudication
Prior to 10/1/17, we did not have a single diagnosis code for lumbar stenosis with neurogenic claudication like we had in ICD-9-CM. However, this changed on 10/1/17 and now there is a code for lumbar stenosis with neurogenic claudication. The reason you experience the denial is because you used a code with 5 characters – M48.06 – which is now invalid. The lumbar stenosis codes now require a 6th character to represent the presence (or not) of neurogenic claudication.
*This response is based on the best information available as of 10/19/17.
Chapter 13 - Diseases of the musculoskeletal system and connective tissue (M00-M99) » Spondylopathies (M45-M49) » Spinal stenosis, lumbar region without neurogenic claudication (M48.061)
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Neurogenic claudication
Publication Date: September 2018
ICD 10 AM Edition: Tenth edition
Query Number: 3400
As there is no Index entry for neurogenic claudication can VICC please advise the correct code for neurogenic claudication secondary to central lumbar canal stenosis? We have queried several cases with a Neurosurgeon who has clarified that this term can be further described as nerve root compression.
If unable to obtain clarification from the clinician and if VICC cannot provide a default code, is it correct to code this to G95.8 Other specified diseases of spinal cord following Index entry:
Disease, diseased
- spinal (cord) G95.9
-- congenital Q06.9
-- specified NEC G95.8.
Response
For documentation of neurogenic claudication secondary to central lumbar canal stenosis where the clinician has clarified that the neurogenic claudication is nerve root compression, VICC considers it appropriate to follow Index entry Compression/nerve/root or plexus/with spinal (vertebra) stenosis or Stenosis/spinal/with nerve root compression to assign M48.06 Spinal stenosis, lumbar region and G55.3 Nerve root and plexus compressions in other dorsopathies.
As the term neurogenic means giving rise to or arising from the nervous system, in the absence of clinical clarification VICC considers the appropriate Index entry to follow for documentation of neurogenic claudication is Disease/nervous system to assign G98 Other disorders of nervous system, not elsewhere classified.
You may wish to send a public submission to ACCD for improvements to the Index.
Videos
M48.062 Spinal stenosis, lumbar region with neurogenic claudication
M48.062 - Spinal stenosis, lumbar region with neurogenic claudication
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