Lawyers PI Program

#85

 From the Desk of:

 Mark Studin DC, FASBE (C), DAAPM, DAAMLP 

 
“Diagnosing Spinal Pain”

 

***Disclaimer***

This consulting session is not intended to direct the care of your patients in any way and is not reflective of any one patient’s condition. You must decide based upon your own clinical results, what is needed to diagnose your patient based upon your clinical findings. This is solely for informational purposes and is not to render a medical opinion and/or advice.

 

Dr. Cory Littman from the Buffalo, NY area sent a question on how to diagnose a patient with continued pain post-cervical disc replacement. In order to understand the answer, you have to understand the term “Dorsopathy.” The answer is far reaching to all of our practices.

[1] http://www.health-care-information.org/fitness/backpain/dorsopathy-basics.html[2] http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gm50.htm+[3] http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gm50.htm+[4] http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gm50.htm+

Back Pain or Dorsopathy Basics[1]

Back Pain (also called Dorsopathy) is pain in back region that is the result of stresses, strains, inflammation, or damage to the muscles, bones, joints, nerves, or other structures that make up the spine. Back pain may be persistent or intermittent, and it may be localized in one place or radiate out to other areas in body. And, pain may be a sharp piercing or burning type of pain, or a dull ache. Back pain may also be spread to the neck and it might also radiate out into an arm and hand, or it may be felt in the upper back, or in the lower back, from where it might radiate out into a leg and foot. Weakness or numbness in arms or legs can also be caused by Back Pain.

 

The World Health Organization in their 2007 update, has added Dorsopathies as a new category for diagnosing pain and this is a very good utilization of codes regarding musculoskeletal conditions. I urge you at the strongest level to read the footnoted links to 2, 3, and 4 prior to utilizing these codes to ensure the proper use of the codes.

Chapter XIII [2][3][4]

 

Diseases of the musculoskeletal system and connective tissue 
(M00-M99)

Dorsopathies 
(M40-M54)

   

 

 

 

 

 

 

 

The following supplementary subclassification to indicate the site of involvement is provided for optional use with appropriate categories in the block on dorsopathies, except categories M50 and M51; see also note at the beginning of this chapter.

0

Multiple sites in spine

1

Occipito-atlanto-axial region

2

Cervical region

3

Cervicothoracic region

4

Thoracic region

5

Thoracolumbar region

6

Lumbar region

7

Lumbosacral region

8

Sacral and sacrococcygeal region

9

Site unspecified


Other dorsopathies 
(M50-M54)

 

 

 

 

 

 

 

 

 

Excludes:

current injury - see injury of spine by body region 
discitis NOS ( M46.4 

 

 

 

 

 

 

 

 

 

M50

 

Cervical disc disorders

 

 

Includes:

cervical disc disorders with cervicalgia 
cervicothoracic disc disorders 

M50.0+

 

Cervical disc disorder with myelopathy ( G99.2* )

M50.1

 

Cervical disc disorder with radiculopathy

 

 

Excludes:

brachial radiculitis NOS ( M54.1 

M50.2

 

Other cervical disc displacement

M50.3

 

Other cervical disc degeneration

M50.8

 

Other cervical disc disorders

M50.9

 

Cervical disc disorder, unspecified

 

 

 

 

 

 

 

 

 

M51

 

Other intervertebral disc disorders

 

 

Includes:

thoracic, thoracolumbar and lumbosacral disc disorders 

M51.0+

 

Lumbar and other intervertebral disc disorders with myelopathy ( G99.2* )

M51.1+

 

Lumbar and other intervertebral disc disorders with radiculopathy (G55.1*)

 

 

Sciatica due to intervertebral disc disorder 

 

 

Excludes:

lumbar radiculitis NOS ( M54.1 

M51.2

 

Other specified intervertebral disc displacement

 

 

Lumbago due to displacement of intervertebral disc 

M51.3

 

Other specified intervertebral disc degeneration

M51.4

 

Schmorl's nodes

M51.8

 

Other specified intervertebral disc disorders

M51.9

 

Intervertebral disc disorder, unspecified

 

 

 

 

 

 

 

 

 

M53

 

Other dorsopathies, not elsewhere classified

 

 

[See site code before M40 ]

M53.0

 

Cervicocranial syndrome

 

 

Posterior cervical sympathetic syndrome 

M53.1

 

Cervicobrachial syndrome

 

 

Excludes:

cervical disc disorder ( M50.- 
thoracic outlet syndrome ( G54.0 

M53.2

 

Spinal instabilities

M53.3

 

Sacrococcygeal disorders, not elsewhere classified

 

 

Coccygodynia 

M53.8

 

Other specified dorsopathies

M53.9

 

Dorsopathy, unspecified

 

 

 

 

 

 

 

 

 

M54

 

Dorsalgia

 

 

[See site code before M40 ]

 

 

Excludes:

psychogenic dorsalgia ( F45.4 

M54.0

 

Panniculitis affecting regions of neck and back

 

 

Excludes:

panniculitis: 
· NOS ( M79.3 
· lupus ( L93.2 
· relapsing [Weber-Christian] ( M35.6 

M54.1

 

Radiculopathy

 

 

Neuritis or radiculitis: 
· brachial NOS 
· lumbar NOS 
· lumbosacral NOS 
· thoracic NOS 
Radiculitis NOS 

 

 

Excludes:

neuralgia and neuritis NOS ( M79.2 
radiculopathy with: 
· cervical disc disorder ( M50.1 
· lumbar and other intervertebral disc disorder ( M51.1 
· spondylosis ( M47.2 

M54.2

 

Cervicalgia

 

 

Excludes:

cervicalgia due to intervertebral cervical disc disorder ( M50.- 

M54.3

 

Sciatica

 

 

Excludes:

lesion of sciatic nerve ( G57.0 
sciatica: 
· due to intervertebral disc disorder ( M51.1 
· with lumbago ( M54.4 

M54.4

 

Lumbago with sciatica

 

 

Excludes:

that due to intervertebral disc disorder ( M51.1 

M54.5

 

Low back pain

 

 

Loin pain 
Low back strain 
Lumbago NOS 

 

 

Excludes:

lumbago: 
· due to intervertebral disc displacement ( M51.2 
· with sciatica ( M54.4 

M54.6

 

Pain in thoracic spine

 

 

Excludes:

pain due to intervertebral disc disorder ( M51.- 

M54.8

 

Other dorsalgia

M54.9

 

Dorsalgia, unspecified

 

 

Backache NOS