Defining the Patient with Lumbar Discogenic Pain: Real-World Implications for Diagnosis and Effective Clinical Management
There is an enormous body of literature that has identified the intervertebral disc as a potent pain generator. However, with regard to lumbar degenerative disc disease, the specific diagnostic criteria lack clarity and fail to capture the primary components which include axial midline low back pain...
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| Published in | Journal of personalized medicine Vol. 13; no. 5; p. 821 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Switzerland
MDPI AG
12.05.2023
MDPI |
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| Online Access | Get full text |
| ISSN | 2075-4426 2075-4426 |
| DOI | 10.3390/jpm13050821 |
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| Abstract | There is an enormous body of literature that has identified the intervertebral disc as a potent pain generator. However, with regard to lumbar degenerative disc disease, the specific diagnostic criteria lack clarity and fail to capture the primary components which include axial midline low back pain with or without non-radicular/non-sciatic referred leg pain in a sclerotomal distribution. In fact, there is no specific ICD-10-CM diagnostic code to classify and define discogenic pain as a unique source of pain distinct from other recognized sources of chronic low back pain including facetogenic, neurocompressive including herniation and/or stenosis, sacroiliac, vertebrogenic, and psychogenic. All of these other sources have well-defined ICD-10-CM codes. Corresponding codes for discogenic pain remain absent from the diagnostic coding vernacular. The International Society for the Advancement of Spine Surgery (ISASS) has proposed a modernization of ICD-10-CM codes to specifically define pain associated with lumbar and lumbosacral degenerative disc disease. The proposed codes would also allow the pain to be characterized by location: lumbar region only, leg only, or both. Successful implementation of these codes would benefit both physicians and payers in distinguishing, tracking, and improving algorithms and treatments for discogenic pain associated with intervertebral disc degeneration. |
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| AbstractList | There is an enormous body of literature that has identified the intervertebral disc as a potent pain generator. However, with regard to lumbar degenerative disc disease, the specific diagnostic criteria lack clarity and fail to capture the primary components which include axial midline low back pain with or without non-radicular/non-sciatic referred leg pain in a sclerotomal distribution. In fact, there is no specific ICD-10-CM diagnostic code to classify and define discogenic pain as a unique source of pain distinct from other recognized sources of chronic low back pain including facetogenic, neurocompressive including herniation and/or stenosis, sacroiliac, vertebrogenic, and psychogenic. All of these other sources have well-defined ICD-10-CM codes. Corresponding codes for discogenic pain remain absent from the diagnostic coding vernacular. The International Society for the Advancement of Spine Surgery (ISASS) has proposed a modernization of ICD-10-CM codes to specifically define pain associated with lumbar and lumbosacral degenerative disc disease. The proposed codes would also allow the pain to be characterized by location: lumbar region only, leg only, or both. Successful implementation of these codes would benefit both physicians and payers in distinguishing, tracking, and improving algorithms and treatments for discogenic pain associated with intervertebral disc degeneration. There is an enormous body of literature that has identified the intervertebral disc as a potent pain generator. However, with regard to lumbar degenerative disc disease, the specific diagnostic criteria lack clarity and fail to capture the primary components which include axial midline low back pain with or without non-radicular/non-sciatic referred leg pain in a sclerotomal distribution. In fact, there is no specific ICD-10-CM diagnostic code to classify and define discogenic pain as a unique source of pain distinct from other recognized sources of chronic low back pain including facetogenic, neurocompressive including herniation and/or stenosis, sacroiliac, vertebrogenic, and psychogenic. All of these other sources have well-defined ICD-10-CM codes. Corresponding codes for discogenic pain remain absent from the diagnostic coding vernacular. The International Society for the Advancement of Spine Surgery (ISASS) has proposed a modernization of ICD-10-CM codes to specifically define pain associated with lumbar and lumbosacral degenerative disc disease. The proposed codes would also allow the pain to be characterized by location: lumbar region only, leg only, or both. Successful implementation of these codes would benefit both physicians and payers in distinguishing, tracking, and improving algorithms and treatments for discogenic pain associated with intervertebral disc degeneration.There is an enormous body of literature that has identified the intervertebral disc as a potent pain generator. However, with regard to lumbar degenerative disc disease, the specific diagnostic criteria lack clarity and fail to capture the primary components which include axial midline low back pain with or without non-radicular/non-sciatic referred leg pain in a sclerotomal distribution. In fact, there is no specific ICD-10-CM diagnostic code to classify and define discogenic pain as a unique source of pain distinct from other recognized sources of chronic low back pain including facetogenic, neurocompressive including herniation and/or stenosis, sacroiliac, vertebrogenic, and psychogenic. All of these other sources have well-defined ICD-10-CM codes. Corresponding codes for discogenic pain remain absent from the diagnostic coding vernacular. The International Society for the Advancement of Spine Surgery (ISASS) has proposed a modernization of ICD-10-CM codes to specifically define pain associated with lumbar and lumbosacral degenerative disc disease. The proposed codes would also allow the pain to be characterized by location: lumbar region only, leg only, or both. Successful implementation of these codes would benefit both physicians and payers in distinguishing, tracking, and improving algorithms and treatments for discogenic pain associated with intervertebral disc degeneration. |
| Audience | Academic |
| Author | Lorio, Morgan P. Lewandrowski, Kai-Uwe Mekhail, Nagy Block, Jon E. Beall, Douglas P. Calodney, Aaron K. |
| AuthorAffiliation | 6 Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; mekhain@ccf.org 2 Clinical Radiology of Oklahoma, 1800 S. Renaissance Blvd., Ste. 110, Edmond, OK 73013, USA; db@clinrad.org 1 Advanced Orthopedics, 499 E. Central Pkwy., Ste. 130, Altamonte Springs, FL 32701, USA; mloriomd@gmail.com 5 Independent Consultant, 2210 Jackson Street, Ste. 401, San Francisco, CA 94115, USA 3 Precision Spine Care, 2737 S. Broadway, Tyler, TX 75701, USA; aaroncalodney@me.com 4 Center for Advanced Spine Care of Southern Arizona, 4787 E. Camp Lowell Drive, Tucson, AZ 85712, USA; business@tucsonspine.com |
| AuthorAffiliation_xml | – name: 5 Independent Consultant, 2210 Jackson Street, Ste. 401, San Francisco, CA 94115, USA – name: 3 Precision Spine Care, 2737 S. Broadway, Tyler, TX 75701, USA; aaroncalodney@me.com – name: 1 Advanced Orthopedics, 499 E. Central Pkwy., Ste. 130, Altamonte Springs, FL 32701, USA; mloriomd@gmail.com – name: 6 Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; mekhain@ccf.org – name: 2 Clinical Radiology of Oklahoma, 1800 S. Renaissance Blvd., Ste. 110, Edmond, OK 73013, USA; db@clinrad.org – name: 4 Center for Advanced Spine Care of Southern Arizona, 4787 E. Camp Lowell Drive, Tucson, AZ 85712, USA; business@tucsonspine.com |
| Author_xml | – sequence: 1 givenname: Morgan P. surname: Lorio fullname: Lorio, Morgan P. – sequence: 2 givenname: Douglas P. orcidid: 0000-0001-8340-696X surname: Beall fullname: Beall, Douglas P. – sequence: 3 givenname: Aaron K. surname: Calodney fullname: Calodney, Aaron K. – sequence: 4 givenname: Kai-Uwe orcidid: 0000-0001-7842-2914 surname: Lewandrowski fullname: Lewandrowski, Kai-Uwe – sequence: 5 givenname: Jon E. orcidid: 0000-0001-9954-8938 surname: Block fullname: Block, Jon E. – sequence: 6 givenname: Nagy surname: Mekhail fullname: Mekhail, Nagy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37240991$$D View this record in MEDLINE/PubMed |
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| Keywords | lumbar diagnosis pain reimbursement discogenic referred |
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| SubjectTerms | Back pain Backache Biomechanics Bone surgery Care and treatment Degeneration Degenerative disc disease Information management Intervertebral discs Low back pain Neural coding Opinion Pain Patients Precision medicine Spine (lumbar) Stenosis Surgeons |
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| Title | Defining the Patient with Lumbar Discogenic Pain: Real-World Implications for Diagnosis and Effective Clinical Management |
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