AS far as our intervertebral discs are concerned, we actually have disc between each vertebrae. There are shock systems just like our shocks in our cars. They have two components. The outside is that tough radio tire like structure. The inside is what gives us the cushion. It's the water gel like nucleus portion. Read this expert coding and compliance article for more.
We can have conditions that we're got a disc displacement. It more frequently occurs in that lower lumbar region especially L4,5 and L5S1. That's the levels that have the most forward flexion extension, more forward flexion where we're bending forward where we use our back to bend over rather than use our legs to bend down to pick something up.
This includes discogenic syndrome, herniation, prolapse, rapture. It also includes radiculitis due to a displacement or a rapture. And so, up at the top, you've got the varying degrees of disc displacement. The bulging disc where we just have a slight bulge out of that annulus, the protrusion where we have more of that nucleus protruding through but it's not had a break through. Those are considered contained disc displacements.
And they'll generally respond well to conservative care. They include disc bulge, disc herniation, disc protrusion. In contrast, the noncontained disc displacements are the extrusion where we’ve actually got nucleus propolsus, that nucleus has gone through all of the radial tire layers of that annulus. And it's extruded out into that spinal canal. And the sequestration, that's what we'll typically see documented as a free fragment. There's a free fragment at that nucleus propolsus that has actually broke free from that extrusion. These are noncontained providers try conservative care at first. But it's not unusual that they have to have surgery intervention.
Well, we have diagnosis medical coding options for reporting disc displacement. Again, they include all those different terms. We don’t have a different diagnosis code for a bulging disc and contrast to a sequestration. They all go under against cervical, lumbar and thoracic. We have the difference in order from anatomical.
There are errors in that different cheat sheets or reference sheets are listed according to numeric order. And in this particular instance, a provider may circle the thoracic when they intend to mark the lumbar because they're out of order compared to anatomic site.
Note those includes. This displacement of the disc includes both low back pain, sciatica and any neuropathy or radiculitis due to we're not going to separately report that fro accutate medical coding and billing.
Disc degeneration is a natural aging process. Just like the spondylosis, the arthritis, that natural aging process from the wear and tear, wear our discs over time, they lose their flexibility. They lose their elasticity. That outside annulus starts to get brittle. We see tiny tears and cracks. That same time, that water rich, that gel water rich center nucleus starts to dry out and shrink.
Spondylosis, the arthritis is likely end result of long-term disc degeneration just because we potentially would have bone on bone.
As that space between that vertebrae gets smaller, that body starts to reacts. The body starts constructing bony growth, bone spurs or osteophytes. Disc degeneration is more likely to occur in people who smoke cigarettes, those who do heavy physical work, heavy machine operators.
It's fairly common though at least 30% of people aged 30 to 50 have some degree of degeneration. And in fact, after the age of 60, some level of disc degeneration is deemed to be a normal finding. So again, just because we have it on a radiologic report, that presence of disc degeneration does not mean that that's the source of the patient’s pain.
Medical coding guidelines do have codes for disc degeneration. Again, cervical, thoracic, lumbar, again, that includes in a degenerative disc disease and that narrowing of the intervertebral disc or space.
Well, speaking of narrowing, we have a condition called spinal stenosis. Stenosis just means we have a narrowing. And there can be stenosis in many parts of the body. We can have a stenosis in our heart valve. We can have a stenosis in the outlet from the stomach.
In this case, there's a stenosis in the small little area, the foraminal openings and the spinal canal where the spinal cord and the spinal nerve exit. And be caused by disc creation. It can be caused by the spondylosis. Or it can be caused by tumor.
Myelopathy may be an in-result of central stenosis. We can have a lateral recess just as that spinal nerve is leaving that spinal cord. Or we can have a foraminal stenosis as that final nerve is leaving that foraminal opening.
We have diagnosis codes, cervical thoracic and lumbar. Note that our cervical spinal stenosis is actually in the 723 category, as per the medical coding rules. In contrast, our thoracic and lumbar is in our 724. Spinal stenosis excludes any conditions due to a collapsed vertebrae. That's our disc compression fractures due to pathologic regions.
It's excludes, we're not going to report the spinal stenosis when it's due to disc disorders, displacement, degeneration, post laminectomy syndrome or spondylosis. And so, it's really important to clearly report when it's a sign or symptom but when it's due to one of these other conditions, we're not going to separately report the spinal stenosis.
Lumbar spinal stenosis is the most common indication of surgery for patients over the age of 60. You may hear that term neurogenic claudication. It just is a combination of that low back pain, leg pain, numbness and potentially even motor weakness. It's caused by some form of spinal stenosis, most typically a central stenosis.
So you'll see maybe these older people walking around with a cane or they're walking in the grocery store with their hands on that grocery cart. And they step away to go and pick something off the shelf and stay bent over because went they stand up, it closes off that central canal. And they get excruciating pain.
And so, it's often eased. So the patient says “This is the only position I can stay in. I can't stand up. I have excruciating pain”. The provider or your provider will start to think that the patient potentially had some form of spinal stenosis.
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