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ICD-10 Guide
ICD-10 CodesM42.16

M42.16

Billable

Adult osteochondrosis of spine, lumbar region

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

Code Description

ICD-10 M42.16 is a billable code used to indicate a diagnosis of adult osteochondrosis of spine, lumbar region.

Key Diagnostic Point:

Adult osteochondrosis of the lumbar spine is a degenerative condition characterized by the deterioration of the intervertebral discs and vertebral bodies in the lower back. This condition often results from age-related changes, repetitive stress, or trauma, leading to pain, stiffness, and potential deformities such as scoliosis or kyphosis. Patients may experience varying degrees of discomfort, which can affect mobility and quality of life. The lumbar region is particularly susceptible due to its weight-bearing function and range of motion. Diagnosis typically involves clinical evaluation, imaging studies such as X-rays or MRI, and assessment of symptoms. Treatment options may include conservative management like physical therapy, pain management, and in some cases, surgical interventions such as spinal fusion to stabilize the affected vertebrae and alleviate pain. Understanding the complexities of this condition is crucial for accurate coding and effective treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for precise documentation of imaging findings
  • Differentiation from other spinal conditions like degenerative disc disease
  • Potential for co-existing spinal deformities

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to document imaging studies that support the diagnosis
  • Misclassification of the severity of the condition
  • Inconsistent coding of associated spinal deformities

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with chronic lower back pain, requiring surgical intervention.

Billing Considerations

Ensure documentation reflects the specific surgical procedure performed and any complications.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes.

Common Clinical Scenarios

Patients undergoing rehabilitation for pain management and functional improvement.

Billing Considerations

Document functional limitations and response to therapy to support coding.

Coding Guidelines

Inclusion Criteria

Use M42.16 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the diagnosis, including any associated conditions
  • Include details on the severity and duration of symptoms, as well as any imaging studies performed

Exclusion Criteria

Do NOT use M42.16 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22630CPT Code

Lumbar spinal fusion

Clinical Scenario

Used for patients with severe lumbar osteochondrosis requiring stabilization.

Documentation Requirements

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

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 lumbar osteochondrosis, improving the accuracy of diagnoses and treatment planning. This specificity aids in better tracking of outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lumbar osteochondrosis, improving the accuracy of diagnoses and treatment planning. This specificity aids in better tracking of outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of lumbar osteochondrosis, improving the accuracy of diagnoses and treatment planning. This specificity aids in better tracking of outcomes and resource allocation.

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 lumbar osteochondrosis?

Common symptoms include lower back pain, stiffness, and potential radiating pain to the legs. Patients may also experience reduced mobility and discomfort during physical activities.