Lumbar Stenosis Diagnosis Code

Lumbar Stenosis Diagnosis Code

October 19, 2017

I just received a claim denial because I used M48.06 (Spinal stenosis, lumbar region) as the diagnosis code. What’s the deal? I’ve been using this diagnosis code without a problem since ICD-10-CM started.

Aha!  There are new diagnosis codes for lumbar stenosis that were effective October 1, 2017.  The code M48.06 is no longer a valid diagnosis code.  Instead, you’ll need to report one of the following 2 diagnosis codes:

M48.061, Spinal stenosis, lumbar region without neurogenic claudication

M48.062, Spinal stenosis, lumbar region with neurogenic claudication

Prior to 10/1/17, we did not have a single diagnosis code for lumbar stenosis with neurogenic claudication like we had in ICD-9-CM.  However, this changed on 10/1/17 and now there is a code for lumbar stenosis with neurogenic claudication.  The reason you experience the denial is because you used a code with 5 characters – M48.06 – which is now invalid.  The lumbar stenosis codes now require a 6th character to represent the presence (or not) of neurogenic claudication.

*This response is based on the best information available as of 10/19/17.


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