DIAGNONIS CODES – MEDICARE
MASTER DIAGNOSIS SHEET – MEDICARE
Patient’s Name: _______________________________________________________ Date: __________________
PRIMARY ICD-9 Dx Codes Names of Vertebra
739.0 Occipitocervical (Occ-C1)
739.1 Cervical (C1-C7)
739.1 C1 (Atlas)
739.1 C2 (Axis)
739.2 Dorsal (D1-D12) or
739.2 Thoracic (T1-T12)
739.3 Lumbar (L1-L5)
739.4 Sacrococcygeal (S)
5. Pelvis
SECONDARY ICD-9 Diagnosis
Category III- ICD-9 (diagnoses that may require longer term treatment):
721.7 Traumatic spondylopathy
722.0 Displacement of cervical intervertebral disc without myleopathy
722.10 Displacement of lumbar intervertebral disc without myleopathy
722.11 Displacement of thoracic intervertebral disc without myelopathy
722.4 Degeneration of cervical intervertebral disc
722.51 Degeneration of thoracic or thoracolumbar intervertebral disc
52. Degeneration of lumbar or lumbrosacral intervertebral disc
722.6 Degeneration of invertebral disc, unspecified site
722.81 Post laminectomy syndrome, cervical region
733.82 Post laminectomy syndrome, thoracic region
722.83 Post laminectomy syndrome, lumbar region
724.3 Sciatica
Current Diagnosis:
1. _______________ 5. _______________
2. _______________ 6. _______________
3. _______________ 7. _______________ DC Signature __________________________________
4. _______________ 8. _______________ Date: _______________________________
Update Diagnosis
1. _______________ 5. _______________
2. _______________ 6. _______________
3. _______________ 7. _______________ DC Signature __________________________________
4. _______________ 8. _______________ Date: _______________________________
Category II- ICD-9 Diagnosis (diagnoses that generally require moderate term treatment):
353.0 Brachial plexus lesions
353.1 Lumbrosacral plexus lesions
353.2 Cervical root lesions, NEC
353.3 Thoracic root lesions, NEC
353.4 Lumbrosacral root lesions, NEC
353.8 Other nerve root and plexus disorders
719.48 Pain in joint (other specified sites) (must specify spine)
720.1 Spinal enthesopathy
722.91 Other and unspecified disc disorder, cervical region
722.92 Other and unspecified disc disorder, thoracic region
722.93 Other and unspecified disc disorder, Lumbar region
723.0 Spinal stenosis in cervical region
723.2 Cervicocranial syndrome
723.3 Cervicobrachial syndrome
723.4 Brachial neuritis or radiculitis
723.5 Torticollis, unspecified
724.01 Spinal stenosis, thoracic region
724.02 Spinal stenosis, lumbar region
724.4 Thoracic or lumbrosacral neuritis or radiculitis
724.6 Disorders of sacrum, ankylosis
724.79 Disorders of coccyx, coccygodynia
724.8 Other symptoms referable to back, facet syndrome
729.1 Myalgia and myositis, unspecified
729.4 Fasciitis, unspecified
738.40 Acquired spondylolisthesis
756.12 Spondylolisthesis
846.0 Sprains & strains of sacroiliac region, lumbosacral (joint;ligament)
846.1 Sprains & strains of sacroiliac region, sacroiliac ligament
846.2 Sprains & strains of sacroiliac region, sacrospinatus (ligament)
846.3 Sprains & strains of sacroiliac region, sacrotuberous (ligament)
846.8 Sprains & strains of sacroiliac region, other specified sites of sacroiliac region
847.0 Sprains & Strains of other and unspecified parts of back, neck
847.1 Sprains & Strains of other and unspecified parts of back, thoracic
847.2 Sprains & Strains of other and unspecified parts of back, lumbar
847.3 Sprains & Strains of other and unspecified parts of back, sacrum
847.4 Sprains & Strains of other and unspecified parts of back, coccyx
Category I-ICD-9 Diagnosis (diagnoses that generally require short term treatment):
81. Tension headache
48. Contracture joint (fixation, spine only)
721.0 Cervical spondylosis without myelopathy
721.2 Thoracic spondylosis without myelopathy
3. Lumbosacral spondylosis without myelopathy
721.6 Ankylosing vertebral hyperostosis
721.90 Spondylosis of unspecified site without myelopathy
721.91 Spondylosis of unspecified site with myelopathy
723.1 Cervicalgia
724.1 Pain in thoracic spine
724.2 Lumbago
724.5 Backache, unspecified
784.0 Headache
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