In October of 2015, the United States government began requiring healthcare practitioners to use a new system of diagnosis codes, called ICD 10, which stands for International Classification of Disease, 10th edition. This article is intended to assist healthcare professionals in using the correct diagnosis codes with cases of scoliosis.
Scoliosis is defined by when it was first diagnosed – not when the patient presents for treatment. For example, a 65 year-old patient who was diagnosed with idiopathic scoliosis as a teenager would be listed using the code M41.129, Adolescent Idiopathic Scoliosis.
The appropriate cause for the scoliosis must also be determined. The code M41 for scoliosis includes kyphoscoliosis (lateral curvature of the spine accompanied by hyperkyphosis of the thoracic spine), but excludes cases of scoliosis caused by bony malformations (congenital), as well as cases of scoliosis which arose as a consequence of surgery or other procedures (post-procedural). So, a 3 year-old who was diagnosed with scoliosis could be listed either as M41.00, or as Q76.3 if hemivertebrae were present.
Next, the location of the scoliosis must be taken into account. Scoliosis is defined by the end vertebrae used to measure the Cobb angle; a case of scoliosis measured from T5 to T12 would be considered thoracic region, whereas a curve measured from T7 to L3 would be thoracolumbar.
Infantile idiopathic scoliosis (M41.00) is defined as a case of scoliosis unaccompanied by congenital abnormalities, detected from birth up to 3 years of age. It is more common in males than in females. Many cases of idiopathic infantile scoliosis tend to spontaneously resolve within a few years; however, those that do not stand a great risk of progressing to severe levels later in life.
Congenital scoliosis due to congenital bony malformation (Q76.3) would be the appropriate code to use in an individual of any age, whose scoliosis developed due to a hemivertebra or other bony malformation that was present at birth. Unlike idiopathic cases, cases of congenital scoliosis never spontaneously resolve.
Congenital deformity of spine (Q67.5) would be used in a case of congenital scoliosis caused by something other than bony malformation, as well as cases of congenital scoliosis not otherwise specified by any other code.
Juvenile idiopathic scoliosis (M41.11) is diagnosed from 3 to 9 years of age. Between the ages of 3 to 6 is considered early-onset juvenile scoliosis; 7 to 9 is considered late-onset juvenile scoliosis; the prognosis is poorer in younger patients, as scoliosis progresses at a higher rate when the patient has growth potential remaining.
Adolescent idiopathic scoliosis (M41.12), commonly abbreviated AIS, is diagnosed after the age of 10 in a skeletally-immature patient (typically up to 17 years of age). It is often quoted that AIS comprises 80% of all scoliosis cases; one should keep in mind that school scoliosis screenings are typically conducted on adolescents, and that we generally stop looking after that. Although the incidence of scoliosis in adolescents is reported to be between 2% to 4.5%, when adults are examined for signs of scoliosis, the incidence has been reported at 12%, 20%, or even 66%. Screening may miss many mild cases of scoliosis, or scoliosis could be developing after the screenings; in either case, this illustrates the importance of screening for scoliosis in all of your patients – not just adolescents. When conducting scoliosis screenings, be sure to use a scoliometer; this device significantly improves the effectiveness of the examination.
Other idiopathic scoliosis (M41.2) is the correct code to use for any case of scoliosis that was not detected before the patient reached skeletal maturity (typically age 18). This includes cases of degenerative (or de novo) scoliosis, which tend to arise in the lumbar spine in individuals past the age of 40 as a consequence of intervertebral disc degeneration and a loss of integrity of the annulus fibrosus. Degenerative scoliosis is often accompanied by lateral listhesis (sideways slippage) of the apical vertebra(e), as well as thin discs, osteophytes, and other signs of spinal degeneration. It is important to recognize degenerative scoliosis as a distinct and separate disease entity from adult idiopathic scoliosis; although both could be considered chronic conditions, the circumstances under which they arose and their subsequent effects upon the body and spinal column will be very different, and require different rehabilitative strategies.
Thoracogenic scoliosis (M41.3) is not a very commonly used code; however, when it is used, it is often used incorrectly. Literally interpreted, “thoracogenic” means, “arising in the thoracic spine.” Thus, one might incorrectly use this code for a case of scoliosis which began in the thoracic spine. However, the Scoliosis Research Society defines thoracogenic scoliosis as, “spinal curvature attributable to disease or operative trauma in or on the thoracic cage.” In reality, this code should only be used when the patient has a case of scoliosis that arose either as a consequence of an operation (such as a thoracotomy or thoracoplasty), or due to a non-neuromuscular disease process, such as a lymphoma.
Postradiation scoliosis (M96.5) is subtly different from thoracogenic scoliosis. It would be used when the radiation treatment for a neuroblastoma, lymphoma, or similar condition induces a scoliosis, as opposed to the disease itself causing the scoliosis.
Neuromuscular scoliosis (M41.4) is the correct code to use for cases of scoliosis associated with neuromuscular disorders, such as cerebral palsy, Friedriech’s ataxia, or poliomyelitis.
Kyphoscoliotic heart disease (I27.1) is used only in a specific set of circumstances: when lateral curvature of the spine (scoliosis) accompanied by thoracic hyperkyphosis causes difficulty breathing due to hypoxemia, which in turn leads to pulmonary hypertension and ventricular hypertrophy. This condition is often found in individuals with Ehlers-Danlos syndrome, and so may be accompanied by a diagnosis of neuromuscular scoliosis.
Ligament laxity and joint hypermobility is commonly found in scoliosis. The combined clinical observations and experiences of scoliosis chiropractors using digital motion x-ray technology have revealed that this ligament laxity extends to the upper cervical spine. This can also be exacerbated by birth trauma, car crashes, or other injuries. According to the WHO, manual manipulation is contraindicated in areas of hypermobility. Only lateral cervical flexion/extension x-rays, A-P Open Mouth lateral flexion x-rays, and digital motion x-ray technology can determine if instability and/or hypermobility exists in the cervical spine. Positive findings would indicate a diagnosis of ligament laxity (M24.28). This could relate to the alar ligament, transverse ligament, anterior/posterior longitudinal ligaments, and the capsular ligaments.
Paraspinal muscles on the concave side of scoliosis exhibit hyper-excitability when the Cobb angle exceeds 30 degrees. In a “typical” scoliosis with a right thoracic Cobb angle and a left lumbar Cobb angle, there would be muscle tightness (not spasm) in the right trapezious and left quadratus lumborum. This would be coded as contracture of muscle, multiple sites (M62.49). Muscle spasm is acute, whereas muscle guarding is a chronic condition that develops as the fast-twitch (Type II) fibers transform into slow-twitch (Type I).
Post-operative cases of scoliosis will need to be accompanied by the proper diagnosis code for the scoliosis (M41.12 for adolescent idiopathic scoliosis, for example), as well as the code Z98.1 (arthrodesis status). This code is grouped within the Diagnostic Related Group (DRG) as a factor influencing health status, and can be used to indicate a variety of types of surgically-induced fusions (as opposed to congenital).
For questions, references, or additional information on the new ICD10 codes for scoliosis, please contact [email protected].