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March 29, 2010

Coding for Scoliosis
For The Record
Vol. 22 No. 6 P. 28

Scoliosis is a sideways curvature of the spine that most frequently occurs during a growth spurt before puberty. Mild scoliosis is usually closely monitored with x-rays to evaluate whether it is getting worse, with no treatment generally required. Severe scoliosis may require surgery to straighten the spine. Most cases have an unknown cause (idiopathic scoliosis), but some causes include neuromuscular conditions such as cerebral palsy or congenital disorders such as birth defects affecting spinal development.

Scoliosis is classified to ICD-9-CM code 737.3. A fifth-digit subclassification is required as follows:

• 737.30, Scoliosis (and kyphoscoliosis), idiopathic;

• 737.31, Resolving infantile idiopathic scoliosis;

• 737.32, Progressive infantile idiopathic scoliosis;

• 737.33, Scoliosis due to radiation;

• 737.34, Thoracogenic scoliosis; and

• 737.39, Other scoliosis.

Congenital scoliosis is classified to code 754.2. Scoliosis due to or associated with another condition is assigned to code 737.43 as a secondary diagnosis. The underlying condition will be coded and sequenced first. Some examples of underlying conditions include the following:

• Charcot-Marie-Tooth disease (356.1);

• mucopolysaccharidosis (277.5);

• neurofibromatosis (237.71);

• osteitis deformans (731.0);

• osteitis fibrosa cystica (252.01);

• osteoporosis (733.00 to 733.09);

• poliomyelitis (138); and

• tuberculosis (Pott’s curvature) (015.0).

Scoliosis is one type of curvature of the spine. Other curvatures of the spine include the following:

• Kyphosis (737.10 to 737.19) is a forward curving of the spine (humpback).

• Lordosis (737.20 to 737.29) is a backward curving of the spine (swayback).

• Kyphoscoliosis (737.30 to 737.39) is the backward and lateral curvature of the spine.

Common signs and symptoms of scoliosis include uneven shoulders (one is higher than the other), one shoulder blade appearing more prominent than the other, uneven waist (tilted pelvis), one hip higher than the other, low back pain, spine fatigue after prolonged sitting or standing, and spine curves to the side.

As the curve gets worse, the spine may twist or rotate in addition to curving. This may cause one side of the ribs to stick out further than the other.

A physician will usually perform a thorough physical exam if scoliosis is suspected. He or she may ask the patient to stand and bend at the waist to check whether one side of the rib cage is more prominent than the other and may order an x-ray to confirm the diagnosis and detect the severity. A neurological exam may also be performed to check for muscle weakness, numbness, and abnormal reflexes. If there is a suspected underlying cause of scoliosis, an MRI, a CT, or a bone scan may be recommended.

In many scoliosis cases, treatment is unnecessary. The physician, however, may recommend a checkup every four to six months to monitor any changes. Factors to consider whether treatment is needed are sex, curve severity, the curve pattern, curve location, and bone maturity.

In some cases, a brace may be recommended to prevent further curve progression. However, a brace will not cure or reverse the curve. It must be worn day and night to be effective, but it can be removed to participate in sports. The patient can stop wearing the brace when the bones stop growing.

Surgery may be necessary in serious cases to reduce the severity of the curve and prevent it from getting worse. The most commonly performed surgery is spinal fusion, which fuses two or more bones together with metal rods, hooks, screws, or wires. Spinal fusion is classified to codes 81.00 to 81.08. Assign an additional code to identify the number of vertebrae fused (81.62 to 81.64). Additional codes are also assigned for any of the following procedures, if performed:

• Insertion of interbody spinal fusion device (84.51);

• Insertion of recombinant bone morphogenetic protein (84.52); and

• Any synchronous excision of (locally) harvested bone for graft (77.70-77.79).

Coding and sequencing for scoliosis are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.