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ICD-10 Guide
ICD-10 CodesM47.16

M47.16

Billable

Other spondylosis with myelopathy, lumbar region

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

Code Description

ICD-10 M47.16 is a billable code used to indicate a diagnosis of other spondylosis with myelopathy, lumbar region.

Key Diagnostic Point:

M47.16 refers to a specific type of spondylosis characterized by degenerative changes in the lumbar spine that lead to myelopathy, which is a neurological condition resulting from spinal cord compression. Spondylosis is a general term for age-related wear and tear affecting the spinal discs and vertebrae. In the lumbar region, this condition can manifest as disc degeneration, facet joint osteoarthritis, and the formation of bone spurs, which may contribute to spinal stenosis. Myelopathy occurs when these degenerative changes compress the spinal cord, leading to symptoms such as weakness, numbness, and coordination difficulties in the lower extremities. This code is used when the spondylosis is not classified under more specific categories like ankylosing spondylitis or other inflammatory spine conditions, making it essential for coders to accurately identify the underlying cause of myelopathy to ensure proper coding and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of spondylosis and myelopathy.
  • Identifying the specific lumbar region affected.
  • Understanding the relationship between spondylosis and other spinal conditions.
  • Documenting neurological deficits accurately.

Audit Risk Factors

  • Inadequate documentation of neurological symptoms.
  • Failure to specify the lumbar region affected.
  • Misclassification of spondylosis type.
  • Lack of correlation between clinical findings and the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, neurological assessments, and treatment plans.

Common Clinical Scenarios

Patients presenting with lower back pain, radiculopathy, or gait disturbances.

Billing Considerations

Ensure that all neurological deficits are documented to support the diagnosis of myelopathy.

Neurology

Documentation Requirements

Comprehensive neurological evaluations and imaging studies.

Common Clinical Scenarios

Patients with symptoms of weakness, numbness, or coordination issues related to lumbar spondylosis.

Billing Considerations

Document the severity and duration of symptoms to justify the diagnosis.

Coding Guidelines

Inclusion Criteria

Use M47.16 When
  • According to ICD
  • 10 guidelines, M47
  • 16 should be used when there is clear documentation of spondylosis with myelopathy specifically in the lumbar region
  • Coders must ensure that the myelopathy is directly attributable to the spondylosis and not due to other conditions

Exclusion Criteria

Do NOT use M47.16 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

63030CPT Code

Laminectomy, lumbar

Clinical Scenario

Used when surgical intervention is required for decompression of the spinal cord.

Documentation Requirements

Operative reports detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery based on neurological deficits.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spondylosis and related conditions, improving the accuracy of diagnoses and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylosis and related conditions, improving the accuracy of diagnoses and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of spondylosis and related conditions, improving the accuracy of diagnoses and treatment plans.

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 spondylosis and myelopathy?

Spondylosis refers to degenerative changes in the spine, while myelopathy is a condition resulting from spinal cord compression due to these changes, leading to neurological symptoms.