What is Lumbar Spinal Stenosis and Neurogenic Claudication
Lumbar spinal stenosis is a descriptive term for narrowing of the lumbar spinal canal, which can cause symptoms but can also be asymptomatic in some individuals. Collecting all patients together under the same code implied that all patients with spinal stenosis were surgical candidates or required some kind of treatment whereas many do not require such intervention. Patients with neurogenic claudication suffer symptoms such as buttock and leg cramps, pain, fatigue, and an exacerbation of symptoms when standing upright. Such symptoms often lead to patients developing a hunched posture to reduce the stenosis and this postural abnormality can cause further problems in the spine.
The New Spinal Stenosis Codes
There were a number of other codes included in the revisions, such as those for nerve tumors, blood type incompatibility, and multiple pregnancies; 141 changes were proposed in all with 121 introduced, 11 invalidated, and 9 revised. The revised code for spinal stenosis is now 2012 ICD-9-CM Diagnosis Code 724.02 (spinal stenosis, other than cervical, lumbar region, without neurogenic claudication), and the new ICD-9-CM Diagnosis Code 724.03 (spinal stenosis, other than cervical, lumbar region, with neurogenic claudication) offers more specificity for doctors and their patients. Patients can, of course, fall into both categories if stenosis is severe enough to cause neurogenic claudication in one region of the spine but less pronounced and/or asymptomatic in another spinal section.
Better Medicare Billing
The codes introduced for these conditions are ICD-9-CM codes which relate to diseases, injuries, symptoms, and conditions and which are closely related to CPT codes associated with the medical services provided by healthcare professionals. The diagnostic code used for a patient’s condition must support the procedure code for Medicare claims to be properly reimbursed. Clearly the codes need to be specific for the system to work properly, which is one reason that Teng asked for the code revisions for spinal stenosis and neurogenic claudication. More than 90% of cases of lumbar spinal stenosis are degenerative, with the prevalence and severity of the condition increasing with age and becoming more common because we now tend to live longer as a population. Lumbar spinal stenosis with neurogenic claudication is actually thought to be the most prevalent condition in those over 55yrs of age and can be as debilitating as cancer, congestive heart failure, or constrictive disease if left untreated.
Managing Spinal Stenosis and Neurogenic Claudication
Many patients with spinal stenosis can be treated conservatively even where neurogenic claudication exists. Physical therapy, NSAIDs, and non-surgical decompression can all help reduce symptoms and delay the need for back surgery. Where non-surgical treatment of spinal stenosis with neurogenic claudication does not address symptoms adequately then surgery to widen the space in the spine and free pinched nerves may be necessary.
Vascular Claudication and Spinal Stenosis
Vascular claudication can also occur in cases of spinal stenosis, leading to a reduction in blood flow and nutrient supply, both of which further compromise nerve root function. Specific motor deficits are uncommon in the early stages with patients instead experiencing vague leg symptoms from the ischaemia and mechanical compression. Many patients with neurogenic claudication find that they can continue cycling even if they have difficulty walking long distances or standing upright for very long. This is due to the action of bending forwards reducing the stenosis in the lumbar spine and thus reducing the constriction of nerves, patients with vascular claudication may find that the opposite is true and bending forwards (as when cycling) is painful. Patients may also be asked if they can walk further when leaning over a shopping cart/trolley as this may also indicate spinal stenosis and intermittent neurogenic claudication.
Patients with neurogenic claudication may be misdiagnosed initially as their symptoms can be confused with those of peripheral vascular disease or diabetic neuropathy. The introduction of new codes to differentiate asymptomatic spinal stenosis and spinal stenosis causing neurogenic claudication offers patients better options for care and more confidence in being reimbursed by Medicare for treatment related to the condition.
Tortolani, P. Justin; Lemma, Mesfin; Riley, Lee H., Managing lumbar spinal stenosis: differentiating between neurogenic and vascular claudication is critical. J Musculoskel Med. 2004;21:10-20.