ICD-10 Coding of Cervical Radiculopathy Underestimates Concurrent Myelopathy.

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-08-21 DOI:10.1097/BSD.0000000000001904

Bradley T Hammoor, David N Bernstein, Ikechukwu C Amakiri, Chierika O Ukogu, Lara L Cohen, Daniel G Tobert

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Abstract

Study design: Retrospective cohort study.

Objectives: To evaluate the accuracy of ICD-10 codes in identifying isolated degenerative cervical radiculopathy versus concurrent myelopathy in surgical patients across an 11-hospital health care system (2016-2023).

Summary of background data: ICD-10 codes are commonly used for patient stratification in database studies, yet their accuracy in differentiating cervical radiculopathy from concurrent myelopathy remains poorly characterized. This distinction is clinically critical as treatment approaches and outcomes differ significantly between these conditions.

Methods: We reviewed 830 surgical patients identified using ICD-10 codes for cervical radiculopathy (M50.10-50.13, M54.11-M54.13, or M25.78). Patients with codes for myelopathy, traumatic, oncologic, or infectious etiologies were excluded. Primary diagnoses were determined through standardized chart review by 3 independent clinical reviewers blinded to ICD-10 codes. Patients were classified using specific criteria: radiculopathy (dermatomal symptoms, positive provocative tests, and foraminal stenosis) and myelopathy (upper motor neuron signs, gait disturbances, fine motor deficits, and cord signal changes on MRI).

Results: Chart review revealed 637 patients (76.7%) had isolated cervical radiculopathy, confirming ICD-10 coding. However, 151 patients (18.2%) presented with concurrent myelopathic symptoms (myeloradiculopathy), and 35 patients (4.2%) demonstrated isolated cervical myelopathy, despite being coded only for radiculopathy. Nondegenerative etiologies comprised 0.8% of cases. The nonspecific code M25.78 showed higher error rates (26%) compared with specific codes, though M54.12 still demonstrated a 22% error rate. Code position significantly influenced accuracy, with error rates increasing from 14% (primary position) to 43% (fourth position).

Conclusions: A significant proportion of patients coded for isolated cervical radiculopathy have concurrent myelopathy that goes unrecognized with ICD-10 coding alone. Code specificity and diagnostic position significantly impact accuracy. Future strategies, including decision support tools and natural language processing, may improve coding accuracy.

Level of evidence: Level III.

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颈神经根病的ICD-10编码低估了并发脊髓病。

研究设计：回顾性队列研究。目的：评估ICD-10代码在11家医院医疗保健系统（2016-2023）中识别孤立性退行性颈椎神经根病与并发性脊髓病的准确性。背景资料摘要：在数据库研究中，ICD-10代码通常用于患者分层，但其在区分颈神经根病和并发性脊髓病方面的准确性仍不明确。这种区别在临床上是至关重要的，因为治疗方法和结果在这些疾病之间存在显著差异。方法：我们回顾了830例使用ICD-10代码（M50.10-50.13, M54.11-M54.13，或M25.78）诊断颈椎神经根病的手术患者。排除脊髓病、创伤、肿瘤或感染性病因的患者。通过3名独立临床审查员对ICD-10编码进行盲法的标准化图表审查确定初步诊断。根据特定标准对患者进行分类：神经根病（皮肤症状、刺激试验阳性和椎间孔狭窄）和脊髓病（上运动神经元体征、步态障碍、精细运动缺陷和MRI上脊髓信号改变）。结果：图表回顾显示637例（76.7%）患者有孤立性颈神经根病，证实了ICD-10编码。然而，151例患者（18.2%）表现为并发脊髓病症状（髓根病），35例患者（4.2%）表现为孤立性颈脊髓病，尽管仅编码为神经根病。非退行性病因占0.8%。非特异性编码M25.78的错误率（26%）高于特异性编码，但M54.12的错误率仍为22%。代码位置显著影响准确性，错误率从14%（主要位置）增加到43%（第四位置）。结论：编码为孤立性颈神经根病的患者中有很大一部分并发脊髓病，仅使用ICD-10编码无法识别。代码特异性和诊断位置显著影响准确性。未来的策略，包括决策支持工具和自然语言处理，可能会提高编码的准确性。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.