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ICD-10 Guide
ICD-10 CodesM41.26

M41.26

Billable

Other idiopathic scoliosis, lumbar region

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

Code Description

ICD-10 M41.26 is a billable code used to indicate a diagnosis of other idiopathic scoliosis, lumbar region.

Key Diagnostic Point:

M41.26 refers to a specific type of idiopathic scoliosis that occurs in the lumbar region of the spine. Idiopathic scoliosis is characterized by an abnormal lateral curvature of the spine, which typically manifests during adolescence. The term 'idiopathic' indicates that the exact cause of the curvature is unknown, distinguishing it from scoliosis caused by other underlying conditions such as congenital malformations or neuromuscular disorders. In the lumbar region, the curvature can lead to significant postural changes, discomfort, and potential complications if left untreated. Patients may present with asymmetry in shoulder height, waistline, or hip alignment. Diagnosis is typically confirmed through physical examination and imaging studies, such as X-rays, which help assess the degree of curvature and its impact on spinal function. Treatment options may vary based on the severity of the curvature and the age of the patient, ranging from observation and bracing to surgical interventions like spinal fusion in more severe cases. Understanding the nuances of this condition is crucial for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of scoliosis
  • Need for precise documentation of curvature measurements
  • Differentiation from other types of scoliosis
  • Potential for co-existing spinal conditions

Audit Risk Factors

  • Inadequate documentation of curvature measurements
  • Failure to specify the lumbar region
  • Misclassification of idiopathic vs. secondary scoliosis
  • Lack of supporting clinical evidence for treatment decisions

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed clinical notes on curvature assessment, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with progressive scoliosis, pre-operative assessments for spinal fusion.

Billing Considerations

Ensure accurate measurement of Cobb angle and documentation of any associated symptoms.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, treatment goals, and progress notes related to scoliosis management.

Common Clinical Scenarios

Rehabilitation post-surgery, conservative management of scoliosis.

Billing Considerations

Documenting the impact of scoliosis on daily activities and quality of life.

Coding Guidelines

Inclusion Criteria

Use M41.26 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's severity and location
  • Include any relevant imaging studies and treatment plans
  • existing

Exclusion Criteria

Do NOT use M41.26 When
  • Exclude conditions that may lead to similar presentations unless they are co

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, lumbar

Clinical Scenario

Used for surgical correction of severe idiopathic scoliosis.

Documentation Requirements

Operative report detailing the procedure, indications, and post-operative care.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery and expected outcomes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of idiopathic scoliosis, improving the accuracy of data collection and reimbursement processes. M41.26 provides a clear distinction from other forms of scoliosis, facilitating better patient management and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of idiopathic scoliosis, improving the accuracy of data collection and reimbursement processes. M41.26 provides a clear distinction from other forms of scoliosis, facilitating better patient management and research.

Reimbursement & Billing Impact

reimbursement processes. M41.26 provides a clear distinction from other forms of scoliosis, facilitating better patient management and research.

Resources

Clinical References

  • •
    American Academy of Orthopaedic Surgeons (AAOS)

Coding & Billing References

  • •
    American Academy of Orthopaedic Surgeons (AAOS)

Frequently Asked Questions

What is the difference between idiopathic and congenital scoliosis?

Idiopathic scoliosis has no known cause and typically develops during adolescence, while congenital scoliosis is due to malformations of the spine present at birth.