Medical Back Problems


MS-DRG	CMS DRG (Prior to 10/1/2007)
551	Medical Back Problems with MCC	243	Medical Back problems
552	Medical Back Problems without MCC

The below listed medical back problem guidelines are not inclusive. The coder should refer to the applicable Coding Clinic guidelines for additional information. The Centers for Medicare & Medicaid Services considers Coding Clinic, published by the American Hospital Association, to be the official source for coding guidelines. Hospitals should follow the Coding Clinic guidelines to assure accuracy in ICD-9-CM coding and DRG assignment.

Definition of Principal Diagnosis

The principal diagnosis is that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

Two or more diagnoses may equally meet the definition for principal diagnosis. This is in terms of the circumstances of admission, diagnostic work-up and/or therapy provided. Be aware that there is a difference between admitting a patient to treat two conditions and two conditions being present at the time of admission. The principal diagnosis is always the reason for admission.

Documentation to Support Medical Back Problems Diagnoses

When reviewing these charts, determine whether or not the medical record documentation substantiates the principal diagnosis as the reason for admission and treatment.

The presence or absence of myelopathy (a functional disturbance and/or pathological change in the spinal cord that is often due to compression) effects the selection of some of these codes. Do not assume the presence of myelopathy. It is important to follow the excludes notes.

If the underlying cause effects the code selection, the documentation needs to include this information.

Coding Guidelines

Category 805/Category 806/Category 952

Category 805 is used for a fracture of the vertebral column without spinal cord injury, category 806 is used for a fracture of the vertebral column with spinal cord injury, and category 952 is used for a spinal cord injury without evidence of spinal bone injury. (See ICD-9-CM, volume 1.)

Excludes notes under categories 723, other disorders of cervical region, and 724, other and unspecified disorders of back

Symptoms and signs associated with (due to) spondylosis and allied disorders, 721.0-721.91, or intervertebral disc disorders, 722.0-722.93 are included in the 721-722 code series. If the physician states the symptoms and signs are not attributed to the conditions noted in the excludes note, then use two codes; one from category 723 or 724 and one for the condition. Spinal stenosis due to degenerative disc disease is classified to the 722 category. Spinal stenosis, congenital or NOS, is classified within the 723-724 categories. (See Coding Clinic, third quarter 1994, page 14 and Coding Clinic, second quarter 1989, page 14.)

Far lateral disc herniation

This is coded using the appropriate code from the 722.0-722.2 series for displacement of intervertebral disc. (See Coding Clinic, first quarter 1988, page 10.)

Fracture/dislocation

A fracture-dislocation of the same site is coded using the fracture code. It is incorrect to use an additional code for the dislocation. Likewise, reduction of the fracture-dislocation is coded using only the code for the reduction of the fracture. (See Coding Clinic, third quarter 1990, page 13.)

Healing fracture/admitted for other acute condition

A patient treated three weeks ago for a hip fracture is admitted to a hospital for treatment of congestive heart failure (CHF). During hospitalization the hip fracture received minimal treatment. The secondary diagnosis of the fracture is coded to V54.9, unspecified orthopedic aftercare. (See Coding Clinic, third quarter 1995, pages 3 and 4.)

Intervertebral disc space infection

This is coded to discitis, 722.90, intervertebral disc disorder, other and unspecified disc disorder, unspecified region. (See Coding Clinic, November- December 1984, page 19.)

Multiple fractures

Multiple fractures of specified sites are coded individually. Combination categories for multiple fractures are only used when there is insufficient documentation, limited space on a reporting form, or there is insufficient specificity at the fourth-digit or fifth-digit level. Multiple fractures are sequenced in order of severity. (See Coding Clinic, September-October 1986, pages 5-9.)

Occipital neuralgia

Occipital neuralgia involves nerve entrapment or impingement and is characterized by pain in the back of the head and suboccipital region. Treatment depends on the symptoms or if the cause is known the treatment is directed toward the cause. Code 723.8, other syndromes affecting cervical region, for occipital neuralgia. If a nerve block is performed, code 04.81, injection of anesthetic into peripheral nerve for analgesia. (See Coding Clinic, first quarter 2000, pages 7 and 8.)

Ocular torticollis

Visual problems causing tilting of the head is referred to as ocular torticollis. Coding depends on the ocular condition causing the torticollis; i.e., nystagmus, code 379.50, strabismus, code 378.9, fourth nerve palsy, code 378.53. The ocular condition is the principal diagnosis with a secondary diagnosis of torticollis, coded 723.5, torticollis, unspecified. (See Coding Clinic, second quarter 2001, page 21.)

Pathologic fracture

A pathologic fracture is a break in a diseased bone due to weakening of the bone structure by pathologic processes, such as osteoporosis or neoplasm, without any identifiable trauma or following only minor trauma. A physician must determine when a patient has severe bone disease if the level of injury is in accordance with the degree of trauma suffered by the patient, so as to determine if the fracture should be coded as a traumatic or pathologic fracture. (See Coding Clinic, fourth quarter 1993, pages 25 and 26.) Spinal cord injury from a pathological compression deformity of T8 with identified vertebral body metastatic carcinoma. This is coded 733.13, pathological fracture of vertebrae (principal diagnosis), 336.3, myelopathy in other diseases classified elsewhere, and 198.5, secondary malignant neoplasm of other specified sites, bone and bone marrow. (See Coding Clinic, third quarter 1999, page 5.)

Postlaminectomy syndrome

Postlaminectomy syndrome is a buildup of scar tissue after a laminectomy has been performed. This can be coded (722.8x) when the physician documents a patient's pain is due to scar tissue formed following disk surgery. If an MRI is done that shows a new herniated disc then the code for the herniated disc should be used. (See Coding Clinic, second quarter 1997, page 15 and Coding Clinic, January-February 1987, page 7.)

Radiofrequency neuroablation for pain reduction

Radiofrequency neuroablation or neurolysis performed to reduce the amount of pain in a patient with a history of a L-1 compression fracture is coded 04.2, Destruction of cranial and peripheral nerves. In radiofrequency neuroablation, electrical energy is used to interrupt pain signals from the joint. The treated nerve normally repairs itself in three to six months. (See Coding Clinic, third quarter 2002, page 11.)

Sandifer syndrome

Sandifer syndrome is synonymous with gastroesophageal reflux and torticollis. Code 530.81, esophageal reflux and 723.5, torticollis. (See Coding Clinic, first quarter 1995, page 7.)

Spinal arachnoiditis due to postoperative scarring

Spinal arachnoiditis due to postoperative scarring following back surgery is manifested by chronic back pain or leg pain. The code assignment is found under postlaminectomy syndrome, 722.8x, or kyphosis, postlaminectomy, 737.12. (See Coding Clinic, January-February 1987, page 7.)

Spontaneous fracture

A spontaneous fracture is one occurring as the result of disease of a bone or from some undiscoverable cause and not due to trauma. These fractures are always pathologic and coded to classification 733.1, pathologic fracture. A physician diagnosis of spontaneous fracture is always coded to classification 733.1, pathologic fracture, regardless of whether or not the documentation includes the underlying condition. (See Coding Clinic, September-October 1985, page 13.)

Stress fracture

Stress fractures are caused by overuse or repetitive jarring of the bone. The most common sites for stress fractures are the metatarsal bones in the feet, the lumbar spine, the neck of the femur and the tibia and fibula. Stress fractures are coded to codes 733.93-5. These codes were new as of October 1, 2001. Previously stress fractures were classified with pathological fractures in classification 733.1, pathologic fracture. (See Coding Clinic, fourth quarter 2001, pages 48 and 49.)

Subluxation of spine/chiropractor

The 839.xx series, other, multiple, and ill-defined dislocations, are not used for conditions treated by a chiropractor. When a subluxation of the spine is treated by a chiropractor, the 739.x series, nonallopathic lesions, NEC, should be used. (See Coding Clinic, fourth quarter 1995, page 51.)