ICD-9 Coding Corner: Specificity Is Key to Diagnosing, Treating Radiculopathy

Because diagnosing radiculopathy (722.0-722.2 and 729.2) can require more than one simple test, practices should know just how to justify claims for these diagnostic procedures and to accurately code radicu-lopathy treatments, such as lumbar diskectomies (62287, Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy).

According to the American Academy of Physical Medicine and Rehabilitation (AAPMR), low back pain is the most common form of physical disability and ranks as the second leading cause of work absenteeism in the United States. Physiatrists who treat lumbar radiculopathy often perform a battery of diagnostic tests to pinpoint the diagnosis, followed by injections or more extensive procedures to treat the condition.

"One major problem with billing these services is that we have to list the patient's symptoms as the ICD-9 code for the diagnostic tests, since we haven't yet confirmed radiculopathy," says Joan Daroy, coding supervisor at The Pain Center, a two-physician practice in Dallas. "Then if we bill for a significant treatment such as diskectomy, the insurer sometimes asks us to back up the diagnosis, saying that the patient's history doesn't reflect it."

Even if the patient's symptoms support the diagnostic tests, the patient's record must include the radiculopathy confirmation to back up any subsequent treatments.
Diagnosis Starts With E/M
An E/M visit (99201-99205 for new patients, 99211-99215 for established patients) is almost always the first stop for patients with back pain. If the physiatrist suspects radiculopathy, he or she performs further testing, such as ankle and knee jerk reflexes and watching patients walk on their toes and perform squats. No code exists for these tests, which should be included in the E/M service.
Symptoms such as decreased patellar reflex, foot sensation loss, quadriceps muscle weakness and anterior leg pain can indicate nerve root compression problems at the L4-L5 level, where about 90 percent of all lower-extremity radiculopathy due to disk herniation occurs, says Gloria Tomlin, RN, office manager at the office of Frederick Tomlin, MD, a physiatrist in Ocean City, Md.

"These symptoms are usually enough to show the insurer that we suspect radiculopathy, allowing us to perform some more extensive tests such as nerve conduction studies (NCS, 95900-95904)." In addition, most carriers allow spinal computed tomography (CT) scans (72125-72133) or magnetic resonance imaging (MRI) testing (72141-72158) to pinpoint which disk has radiculopathy.
Watch EDX Test Frequency Guidelines
The American Association of Electrodiagnostic Medicine (AAEM)'s Recommended Policy for Electrodiagnostic (EDX) Testing, which is a recommendation on the "maximum [...]