Lumbar Spinal Stenosis Can Be a Pain!

Becky Buegel, RHIA, CDIP, CHP Medical Coding Leave a Comment

Lumbar Spinal Stenosis Can Be a Pain!

Lumbar spinal stenosis can be a pain in the – um, rump, to be polite. While causing pain in other areas of the spine, the most common area is the lower back. Lumbar spinal stenosis, or for the sake of expediency in this blog, LSS, occurs when the space inside the vertebrae is too small; the narrowed space puts pressure on the spinal cord and nerves.

Though LSS often causes no symptoms, when it does, they start slowly and worsen over time. Symptoms depend on the part of the spine that is affected.

LSS symptoms include, among other things:

  • Back pain, cramping in either/both legs that range from a dull ache to an electric-like/burning sensation
  • Heaviness in legs
  • Cramping
  • Sciatic pain
  • “Pins and needles” in buttocks, leg(s), or foot/feet
  • Pain that worsens while standing
  • Bladder and/or bowel dysfunction

Causes

Causes are many, though whatever causes LSS changes the structure of the spine, narrowing the space and putting pressure on the spinal cord and nerves. Common causes include:

  • Osteoarthritis
  • Bulging/herniated intervertebral disks
  • Thickened ligaments that hold the spine together
  • Spinal fractures/injuries
  • Spinal cord cysts or tumors
  • Paget’s disease
  • Congenital spinal stenosis

Diagnosis

LSS is diagnosed after examination by a healthcare professional who reviews the patient’s medical history, symptoms, and performs a physical exam. Imaging tests are also part of the diagnostic process, as they allow the provider to determine the location and extent of the problem. Common studies include:

  • X-rays – reveals changes in bone structure like loss of disk height and bone spurs
  • MRI – provides detailed images of the nerves, disks, and spinal cord, along with the presence of any tumors
  • CT/CT myelogram – creates cross-sectional images of the spine. A CT myelogram allows more clear images of the spinal cord and nerves

Treatments for LSS

Traditionally, non-surgical treatments include:

  • Oral medications like NSAIDs
  • Acupuncture
  • Chiropractic manipulation
  • PT
  • Epidural and/or steroid Injections

Minimally-invasive treatments for LSS include:

  • MILD®/PILD – Percutaneous Image-guided Lumbar Decompression/Minimally Invasive Lumbar Decompression - Requiring no general anesthesia, or stitches, the procedure includes injecting a contrast agent; special tools remove a section of thickened ligament, reducing compression on nerve roots. Patients are usually discharged several hours post-procedure. PT is prescribed to aid in strengthening weakened musculature.
  • Vertiflex™ Procedure – A titanium spacer is implanted via image guidance through a tiny tube in the lower back. Once inserted, the spacer’s arms open around the spinous process of the lumbar spine to lock the device in place, thus creating and maintaining space for affected nerves, and relieving pressure that causes pain.

Though usually considered last, surgical treatments include:

  • Laminectomy
  • Laminotomy
  • Foraminotomy
  • Spinal fusion

In Conclusion

No matter the cause, LSS can be very painful for patients afflicted with this diagnosis. Treatment options depend on the specifics of the actual stenosis. Typically, if conservative treatments fail to correct lumbar spinal stenosis, there are both minimally invasive treatment options and more invasive surgeries that can be considered.

See attached charts for LSS diagnoses and procedure codes. The Medicare Coverage Information offers detailed information on coding and billing for the minimally-invasive treatments.

ICD-10-CM Lumbar Region Spinal Stenosis Codes 

ICD-10-CM CODE

NARRATIVE

M48.061

Spinal stenosis, lumbar region without neurogenic claudication

Spinal stenosis, lumbar region NOS

M48.062

Spinal stenosis, lumbar region with neurogenic claudication

Lumbar Region Spinal Procedure Codes 

PROCEDURE CLASSIFICATION
SYSTEM

CODE NUMBER

PROCEDURE

NAME

NARRATIVE

ICD-10-PCS

0QH044Z

Vertiflex™ Procedure

Insertion of Internal Fixation Device into Lumbar Vertebra, Percutaneous Endoscopic Approach

CPT

0275T

MILD®/PILD

Percutaneous laminotomy/ laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbar

Spinal Stenosis References:

MEDICARE COVERAGE INFORMATION:

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