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v1.0.0
ICD-10 Guide
ICD-10 CodesM41.86

M41.86

Billable

Other forms of scoliosis, lumbar region

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M41.86 is a billable code used to indicate a diagnosis of other forms of scoliosis, lumbar region.

Key Diagnostic Point:

M41.86 refers to other forms of scoliosis specifically affecting the lumbar region of the spine. Scoliosis is characterized by an abnormal lateral curvature of the spine, which can occur in various forms, including idiopathic, congenital, and neuromuscular scoliosis. In the lumbar region, this curvature can lead to significant postural changes, discomfort, and functional limitations. Patients may present with symptoms such as back pain, uneven shoulders or hips, and in severe cases, respiratory issues due to compromised thoracic space. The etiology of lumbar scoliosis can vary, with some cases arising from developmental anomalies, while others may be secondary to conditions like muscular dystrophy or cerebral palsy. Diagnosis typically involves clinical examination and imaging studies, such as X-rays, to assess the degree of curvature and its impact on spinal alignment. Treatment options may include physical therapy, bracing, or surgical interventions like spinal fusion, depending on the severity and progression of the curvature. Accurate coding is essential for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to scoliosis.
  • Differentiation from other spinal deformities such as kyphosis and lordosis.
  • Need for precise documentation of curvature degree and progression.
  • Potential for co-existing conditions affecting treatment and coding.

Audit Risk Factors

  • Inadequate documentation of the type of scoliosis.
  • Failure to specify the degree of curvature.
  • Lack of clarity on the underlying cause of scoliosis.
  • Improper linkage between diagnosis and treatment procedures.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed imaging reports, surgical notes, and pre-operative assessments.

Common Clinical Scenarios

Patients presenting with progressive scoliosis requiring surgical intervention.

Billing Considerations

Documentation must clearly outline the rationale for surgical procedures like spinal fusion.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes.

Common Clinical Scenarios

Patients undergoing conservative management for scoliosis.

Billing Considerations

Focus on functional outcomes and the impact of scoliosis on daily activities.

Coding Guidelines

Inclusion Criteria

Use M41.86 When
  • According to ICD
  • 10 coding guidelines, M41
  • 86 should be used when the specific type of scoliosis affecting the lumbar region is documented
  • It is important to include any relevant clinical details that support the diagnosis, such as imaging findings and treatment history

Exclusion Criteria

Do NOT use M41.86 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, lumbar

Clinical Scenario

Used when surgical intervention is required for severe lumbar scoliosis.

Documentation Requirements

Operative reports detailing the procedure and indications for surgery.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention clearly.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of scoliosis types, improving the accuracy of patient records and treatment plans. M41.86 provides a distinct code for lumbar scoliosis, facilitating better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of scoliosis types, improving the accuracy of patient records and treatment plans. M41.86 provides a distinct code for lumbar scoliosis, facilitating better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of scoliosis types, improving the accuracy of patient records and treatment plans. M41.86 provides a distinct code for lumbar scoliosis, facilitating better tracking of treatment outcomes and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between M41.86 and M41.9?

M41.86 is used for specific forms of lumbar scoliosis, while M41.9 is a general code for unspecified scoliosis. Accurate documentation is crucial for selecting the appropriate code.