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ICD-10 Guide
ICD-10 CodesM42.1

M42.1

Billable

Adult osteochondrosis of spine

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

Code Description

ICD-10 M42.1 is a billable code used to indicate a diagnosis of adult osteochondrosis of spine.

Key Diagnostic Point:

Adult osteochondrosis of the spine refers to a degenerative condition affecting the intervertebral discs and vertebrae, primarily seen in adults. It is characterized by the degeneration of the cartilage and bone, leading to pain, stiffness, and potential deformities of the spine. This condition can result in various spinal deformities such as scoliosis (lateral curvature of the spine), kyphosis (excessive outward curvature), and lordosis (excessive inward curvature). The degeneration may lead to disc herniation, spinal stenosis, and other complications that can significantly impact mobility and quality of life. Diagnosis typically involves clinical evaluation, imaging studies such as X-rays or MRI, and assessment of symptoms. Treatment options may include conservative management with physical therapy, pain management, and in severe cases, surgical interventions such as spinal fusion to stabilize the spine and alleviate symptoms. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Potential for co-existing spinal conditions (e.g., scoliosis, kyphosis)
  • Need for detailed documentation of imaging findings
  • Differentiation from other spinal disorders

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document co-existing conditions
  • Lack of imaging studies to support diagnosis
  • Improper linkage of diagnosis to treatment procedures

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed surgical notes, imaging results, and pre-operative assessments.

Common Clinical Scenarios

Patients presenting with chronic back pain, requiring surgical intervention for spinal stabilization.

Billing Considerations

Ensure clear documentation of the rationale for surgical procedures and any pre-existing conditions.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional status and treatment plans.

Common Clinical Scenarios

Patients undergoing rehabilitation for pain management and mobility improvement.

Billing Considerations

Document the patient's progress and response to therapy to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M42.1 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the condition's severity and any associated spinal deformities
  • Include relevant imaging and clinical findings to support the diagnosis

Exclusion Criteria

Do NOT use M42.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, posterior technique

Clinical Scenario

Used when surgical intervention is required for stabilization due to osteochondrosis.

Documentation Requirements

Surgical notes detailing the procedure, indications, and post-operative care.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery and any pre-existing conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of osteochondrosis, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the condition's prevalence and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of osteochondrosis, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the condition's prevalence and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of osteochondrosis, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better understanding the condition's prevalence and treatment outcomes.

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 are the common symptoms of adult osteochondrosis of the spine?

Common symptoms include chronic back pain, stiffness, reduced range of motion, and potential neurological symptoms if nerve roots are compressed.

How is adult osteochondrosis diagnosed?

Diagnosis typically involves a combination of clinical evaluation, patient history, physical examination, and imaging studies such as X-rays or MRI.