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.