Adult osteochondrosis of spine, site unspecified
ICD-10 M42.10 is a billable code used to indicate a diagnosis of adult osteochondrosis of spine, site unspecified.
Adult osteochondrosis of the spine refers to a degenerative condition affecting the intervertebral discs and vertebrae, leading to pain, stiffness, and potential deformities. This condition is characterized by the degeneration of cartilage and bone, often resulting in osteophyte formation and disc herniation. Patients may present with symptoms such as chronic back pain, reduced mobility, and neurological deficits if nerve roots are compressed. The condition can lead to spinal deformities, including scoliosis (lateral curvature of the spine), kyphosis (excessive outward curvature), and lordosis (excessive inward curvature). These deformities can further complicate the clinical picture, necessitating interventions such as spinal fusion procedures to stabilize the spine and alleviate pain. The unspecified site indicates that the exact location of the osteochondrosis is not documented, which can complicate treatment planning and coding accuracy. Proper diagnosis and management require a comprehensive evaluation, including imaging studies and clinical assessments, to determine the extent of degeneration and any associated deformities.
Detailed notes on physical examination findings, imaging results, and treatment plans.
Patients presenting with chronic back pain and deformities requiring surgical intervention.
Documentation must clearly outline the rationale for surgical procedures such as spinal fusion.
Comprehensive assessments of functional limitations and treatment progress.
Patients undergoing rehabilitation for pain management and mobility improvement.
Focus on documenting the impact of osteochondrosis on daily activities and rehabilitation goals.
Used for patients with osteochondrosis requiring stabilization.
Operative reports detailing the procedure and indications.
Orthopedic surgeons must document the rationale for fusion in the context of osteochondrosis.
The unspecified site indicates that the exact location of osteochondrosis is not documented, which can complicate treatment planning and coding accuracy. It is essential to strive for specificity in documentation to improve patient care and coding accuracy.
