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ICD-10 Guide
ICD-10 CodesChapter 13: Diseases of the musculoskeletal systemM42

M42

Billable

Spinal osteochondrosis

Chapter 13:Diseases of the musculoskeletal system

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

Code Description

ICD-10 M42 is a billable code used to indicate a diagnosis of spinal osteochondrosis.

Key Diagnostic Point:

Spinal osteochondrosis refers to a group of disorders characterized by degeneration of the intervertebral discs and associated vertebral bodies, leading to pain, deformity, and potential neurological deficits. This condition often manifests in children and adolescents, where it can result in spinal deformities such as scoliosis, kyphosis, and lordosis. The degeneration is typically due to repetitive stress or trauma, leading to changes in the cartilage and bone structure of the spine. Patients may present with symptoms including back pain, stiffness, and reduced mobility. In severe cases, spinal fusion procedures may be indicated to stabilize the spine and alleviate pain. The condition can also lead to complications such as nerve root compression, which may require surgical intervention. Accurate diagnosis often involves imaging studies such as X-rays or MRI to assess the extent of degeneration and any associated deformities.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of symptoms
  • Differentiation from other spinal disorders
  • Need for precise documentation of associated deformities
  • Potential for surgical intervention and related coding

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to specify the type of spinal deformity present
  • Incorrect coding of associated procedures (e.g., spinal fusion)
  • Lack of clarity on the relationship between osteochondrosis and other conditions

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with back pain and deformities requiring surgical evaluation.

Billing Considerations

Documentation must clearly outline the relationship between osteochondrosis and any spinal deformities.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery for spinal deformities.

Billing Considerations

Focus on documenting the impact of osteochondrosis on daily activities and quality of life.

Coding Guidelines

Inclusion Criteria

Use M42 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the condition's severity and any associated deformities
  • Include relevant imaging studies and clinical findings to support the diagnosis

Exclusion Criteria

Do NOT use M42 When
No specific exclusions found.

Related CPT Codes

22612CPT Code

Spinal fusion, posterior technique

Clinical Scenario

Used in cases of severe spinal deformity due to osteochondrosis requiring stabilization.

Documentation Requirements

Operative report detailing the procedure, indications, and any complications.

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 spinal conditions, including osteochondrosis, which enhances the ability to capture the complexity of these disorders and their treatment.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spinal conditions, including osteochondrosis, which enhances the ability to capture the complexity of these disorders and their treatment.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of spinal conditions, including osteochondrosis, which enhances the ability to capture the complexity of these disorders and their treatment.

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 primary cause of spinal osteochondrosis?

Spinal osteochondrosis is primarily caused by repetitive stress or trauma to the spine, leading to degeneration of the intervertebral discs and vertebrae.

How is spinal osteochondrosis diagnosed?

Diagnosis is typically made through a combination of clinical evaluation, patient history, and imaging studies such as X-rays or MRI.

What are the treatment options for spinal osteochondrosis?

Treatment options may include physical therapy, pain management, and in severe cases, surgical interventions such as spinal fusion.