Diagnosis Dilemmas – Foraminal Stenosis
If you are coding for a neurosurgery or chronic pain practice, chances are you have coded many reports with a diagnosis of “foraminal stenosis.” But if you look up “stenosis” in the index of ICD-10-CM, you won’t find a subentry for “foraminal” or “neural foramen.” The lack of a specific entry for this condition in ICD-10-CM has generated questions about how to code the diagnosis of foraminal stenosis. Today’s article will focus on gaining a better understanding of what this term means and how to code this condition.
Foraminal stenosis is a narrowing of a small canal/passageway called the neural foramen. The nerve roots branch off the spinal cord and pass through this canal. If you are someone like me who can understand concepts better through pictures, check out this link for an image of the nerve roots passing through the small neural foramen: Image: Neural Foramen. When this small canal becomes narrowed due to osteophytes (bone spurs), degenerative arthritis of the spine, or other conditions like herniated disc fragments, those nerve roots passing through the canal can get pinched/squeezed which can be very painful. So you may see procedures like a decompression or herniated disc removal performed to try to take pressure off those exiting nerve roots in the neural foramen.
Okay, now let’s come back to the question of how do we code “foraminal stenosis” when ICD-10-CM doesn’t offer a clear option under stenosis>foraminal? The answer is to go to stenosis>spinal, and select the spinal stenosis code for the appropriate level of the spine (e.g., lumbar). Foraminal stenosis is a specific type of spinal stenosis so it is accurate to code this condition under stenosis>spinal with code in category M48.0-.
References:
AHA Coding Clinic – 7/1/2018