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ICD-10 Guide
ICD-10 CodesM41.124

M41.124

Billable

Adolescent idiopathic scoliosis, thoracic region

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

Code Description

ICD-10 M41.124 is a billable code used to indicate a diagnosis of adolescent idiopathic scoliosis, thoracic region.

Key Diagnostic Point:

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity characterized by lateral curvature of the spine, typically diagnosed in children and adolescents aged 10 to 18 years. The thoracic region is the most commonly affected area, leading to a curvature that can result in postural changes, respiratory issues, and psychosocial impacts. The etiology of AIS remains largely unknown, although genetic factors may play a role. Diagnosis is primarily through clinical examination and radiographic evaluation, with Cobb angle measurement being the standard for assessing the degree of curvature. Treatment options vary based on the severity of the curvature and the patient's growth potential, ranging from observation and bracing to surgical interventions such as spinal fusion. The goal of treatment is to prevent progression of the curve and to maintain spinal balance and function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in curvature severity and progression
  • Need for precise measurement of Cobb angle
  • Differentiation from other types of scoliosis
  • Documentation of growth potential and treatment response

Audit Risk Factors

  • Inadequate documentation of curvature measurements
  • Failure to note the patient's growth potential
  • Misclassification of scoliosis type
  • Lack of follow-up documentation on treatment efficacy

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed clinical notes on curvature measurements, treatment plans, and follow-up assessments.

Common Clinical Scenarios

Surgical intervention for severe curves, bracing recommendations for moderate curves.

Billing Considerations

Ensure accurate documentation of pre-operative assessments and post-operative outcomes.

Pediatrics

Documentation Requirements

Growth charts, family history of scoliosis, and developmental assessments.

Common Clinical Scenarios

Routine screening for scoliosis during well-child visits.

Billing Considerations

Document any psychosocial impacts on the adolescent patient.

Coding Guidelines

Inclusion Criteria

Use M41.124 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the curvature's severity and any associated conditions
  • Include specific details about the patient's age and growth status

Exclusion Criteria

Do NOT use M41.124 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22610CPT Code

Spinal fusion, posterior or posterolateral technique

Clinical Scenario

Used for surgical correction of severe adolescent idiopathic scoliosis.

Documentation Requirements

Pre-operative assessments, surgical notes, and post-operative follow-up.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention.

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 data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of scoliosis types, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Academy of Orthopaedic Surgeons (AAOS)

Coding & Billing References

  • •
    American Academy of Orthopaedic Surgeons (AAOS)

Frequently Asked Questions

What is the primary treatment for adolescent idiopathic scoliosis?

The primary treatment for adolescent idiopathic scoliosis depends on the severity of the curve. Mild cases may be monitored, while moderate cases may require bracing. Severe cases often necessitate surgical intervention, such as spinal fusion.