Coding Cervical Myelopathy – A Degenerative Disorder of the Cervical Spine

0:00 – Hello everyone and Welcome to our Podcast series. My name is Natalie Tornese and I’m the Senior Group Manager for Outsource Strategies International (OSI). I wanted to talk little bit about coding Cervical Myelopathy.

0:13 –Introduction on Cervical Myelopathy

As people age, their body undergoes several changes. In certain cases, parts of the body may succumb to severe structural changes that cause pain. Several degenerative disorders may impact the cervical spine. Cervical Myelopathy is a disorder that causes compression of the spinal cord in the cervical spine. The cervical spine comprises of seven vertebrae (C1 to C7) – with six inter-vertebral discs and eight nerve roots. Any space-occupying injury within the cervical spine that can cause compression can lead to cervical myelopathy. Treatment for this condition may depend on the severity and type of injury and in most cases, involves a combination of non-surgical and surgical techniques.

0:58 – Types of Cervical Myelopathy

There are three types of cervical myelopathy. One common type is cervical spondylotic myelopathy which relates to the gradual degeneration of the spine that happens as people age. This type is more common in people that are aged 50 years and older. In fact, the gradual degeneration of the spine often takes different forms of cervical spinal stenosis. In some cases, people are born with a narrow spinal canal and may experience myelopathy sooner than others if further narrowing occurs. On the other hand, bulging or herniated discs and bone spurs in the neck are other forms of spinal degeneration that can put severe pressure on the spinal cord and cause myelopathy. Apart from the gradual wear and tear of the spine, cervical myelopathy can also be caused by hardening of the ligaments surrounding the spinal cord. Other related causes of this condition include spinal infections, spinal tumors and cancers, rheumatoid arthritis of the neck and whiplash injury or other cervical spine trauma.

2:03 – Signs and Symptoms

Symptoms include neck pain, reduced range of motion, stiffness in the neck, weakness, numbness or tingling in the arms, hands, and balance issues. The signs and symptoms may develop slowly. Due to the lack of pain, there may be a large interval of time between the onset of the disease and the first treatment. Some of the early symptoms include loss of dexterity in your fingers, atrophy of the muscles, difficulty in fine finger movements, weakness in the arms and hands, numbness or tingling in the arms and hands, clumsiness and poor coordination of the hands, difficulty handling small objects (like pens or coins), loss of strength and balance issues and increased reflexes in the lower extremities and in the upper extremities below the level of the lesion. As this condition progresses, patients may experience a shooting pain that originates in the neck and travels down the spine. Even though many people experience neck pain, not all neck pain can be traced back to cervical myelopathy. In some cases, patients with this condition don’t have any neck pain at all. At a later stage, symptoms like upper extremity numbness and gait disturbance may also occur and some individuals may even become wheelchair dependent.

3:22 – Diagnosis and Treatment

The diagnosis of this condition may begin with a physical exam to measure the muscle strength and reflexes in a detailed manner. Several imaging tests like an MRI or an X-ray or a CT myelogram of the neck, may be performed. In addition, nerve conduction studies may be performed as well to measure how well the nerves in the arms and hands communicate with the brain through the spinal cord. The treatment for this condition involves a combination of non-surgical and surgical techniques. Mild cases may require conservative treatment to reduce symptoms. Non-surgical treatments include physical therapy, prescription medications or even utilizing a cervical collar for a specific period of time. If these conservative treatment methods fail to provide relief, surgical intervention may be necessary. The decision or choice of surgical procedure will vary depending on the patient’s specific symptoms and where exactly the spinal cord is compressed. Common surgical procedures include laminoplasty which involves widening of the spinal canal and spinal fusion surgery to stabilize the spine. I will include a transcript of all ICD-10 codes associated with this condition along with this recording.

ICD-10 diagnosis codes for cervical myelopathy

• M50 Cervical disc disorders
• M50.0 Cervical disc disorder with myelopathy
  • M50.00 Cervical disc disorder with myelopathy, unspecified cervical region
  • M50.01 Cervical disc disorder with myelopathy, high cervical region
  • M50.02 Cervical disc disorder with myelopathy, mid-cervical region
    • M50.020 Cervical disc disorder with myelopathy, mid-cervical region, unspecified level
    • M50.021 Cervical disc disorder at C4-C5 level with myelopathy
    • M50.022 Cervical disc disorder at C5-C6 level with myelopathy
    • M50.023 Cervical disc disorder at C6-C7 level with myelopathy
  • M50.03 Cervical disc disorder with myelopathy, cervicothoracic region

4:39 – Importance of Professional Diagnosis

As the early signs and symptoms of cervical myelopathy may often resemble or be mistaken as a normal sign of aging, it is important for patients to never self-diagnose the condition. Self-diagnosing or experimenting with different treatment methods or home remedies is not recommended as this may worsen the condition. A professional spine specialist can correctly guide a patient with a clear diagnosis and thorough details about their cervical condition.

I hope this helps but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.  Thank You.