D. SPINAL PAIN, SECTION 2: SPINAL AND RADICULAR PAIN SYNDROMES OF THE CERVICAL AND THORACIC REGIONS N.B. For explanatory material on this section and on section G, Spinal and Radicular Pain Syndromes of the Lumbar, Sacral, and Coccy eal Re ions, see pp. 11-16 in the list of Topics and Codes. Please also note the comments on codin on p. 17. GROUP IX: CERVICAL OR RADICULAR SPINAL PAIN SYNDROMES Cervica Spina or Radicu ar Pain Attributab e to a Fracture (IX-1) Definition Cervical spinal pain occurrin in a patient with a history of in(ury in whom radio raphy or other ima in studies demonstrate the presence of a fracture that can reasonably be interpreted as the cause of the pain. C inica Features Cervical spinal pain with or without referred pain. Dia.nostic Features Radio raphic or other ima in evidence of a fracture of one of the osseous elements of the cervical vertebral column. Schedu e of Fractures IX- 1.1(S,(R, Fracture of a -ertebral Body Code 1...X1eS/C 0...X1eR IX- 1.0(S, Fracture of a Spinous Process (Synonym1 2clay-shovelers fracture3, Code 1...XIfS IX-1..(S,(R, Fracture of a Transverse Process Code 1...Xl S/C 0...X1fR IX- 1.4(S,(R, Fracture of an Articular Pillar Code 1...XIhS/C 0...X1 R IX-1.5(S,(R, Fracture of a Superior Articular Process Code 1...X1iS/C 0...X1hR IX- 1.6(S,(R, Fracture of an Inferior Articular Process Code 1...X1(S/C 0...X1iR IX-1.7(S,(R, Fracture of Lamina Code 1...X17S/C 0...X1uR IX-1.8(S,(R, Fracture of the Odontoid Process Code 1...XIIS/C 0...X1vR IX-1.9(S,(R, Fracture of the Anterior Arch of the Atlas Code 1...X1mS/C 0...X1pR IX-1.10(S,(R, Fracture of the Posterior Arch of the Atlas Code 1...XlnS/C 0...XIqR IX- 1.11(S,(R, Burst Fracture of the Atlas Code 1...X1oS/C 0...XlwR Cervica Spina or Radicu ar Pain Attributab e to an Infection (IX-2) Definition Cervical spinal pain occurrin in a patient with clinical or other features of an infection, in whom the site of infection can be specified and which can reasonably be interpreted as the source of the pain. C inica Features Cervical spinal pain with or without referred pain, associated with pyrexia or other clinical features of infection. Dia.nostic Features A presumptive dia nosis can be made on the basis of an elevated white cell count or other serolo ical features of infection, to ether with ima in evidence of the presence of a site of infection in the cervical vertebral column or its adnexa. Absolute confirmation relies on histolo ical and/or bacteriolo ical confirmation usin material obtained by direct or needle biopsy. Schedu e of Sites of Infection IX-0. 1(S,(R, Infection of a -ertebral Body (Osteomyelitis, Code 1.0.X0aS/C 0.0.X0iR IX-0.0(S,(R, Septic Arthritis of a Zy apophysial Joint Code 1.0.X0bS/C 0.0.X0(R IX-0..(S,(R, Septic Arthritis of an Atlanto-Axial Joint Code 1.0.X0cS/C 0.0.X0cR IX-0.4(S,(R, Infection of the Prevertebral Muscles or Space Code 1.0.X0dS/C 0.0.X07R IX-0.5(S,(R, Infection of an Intervertebral Dis7 (Dis7itis, Code 1.0.X0eS/C 0.0.X01R IX-0.6(S,(R, Infection of an Interbody Graft Code 1.0.XtS/C 0.0.X0mR IX-0.7(S,(R, Infection of a Posterior Fusion Code 1.0.X0 S/C 0.0.X0nR IX-0.8(S,(R, Infection of the Apidural Space (Apidural Abscess, Code 1.0.X0hS/C 0.0.X0oR IX-0.9(S,(R, Infection of the Spinal Menin es (Menin itis, Code 10..X0cS/C 00..X0cR IX-0.10(S,(R, Berpes Zoster Acute Code 10..X0dS/C 00..X0dR IX-0.1 1(S,(R, Postherpetic Neural ia Code 10..X0eS/C 00..X0eR IX-0.10(S,(R, Syphilis1 Tabes Dorsalis and Bypertrophic Pachymenin itis Code 107.X0CS/C 007.X0CR IX-0.1.(S,(R, Other Syphilitic Chan es, Includin Gumma (No Code, Cervica Spina or Radicu ar Pain Attributab e to a Neop asm (IX-1) Definition Cervical spinal pain associated with a neoplasm that can reasonably be interpreted as the source of the pain. C inica Features Cervical spinal pain with or without referred pain. Dia.nostic Features A presumptive dia nosis may be made on the basis of ima in evidence of a neoplasm that directly or indirectly affects one or other of the tissues innervated by cervical spinal nerves. Absolute confirmation relies on obtainin histolo ical evidence by direct or needle biopsy. Schedu e of Neop astic Diseases IX-.. I (S,(R, Primary Tumor of a -ertebral Body Code 1...X4aS/C 0...X4aR IX-..0(S,(R, Primary Tumor of Any Part of a -ertebra Other than Its Body Code 1...X4bS/C 0...X4bR IX-... (S,(R, Primary Tumor of a Zy apophysial Joint Code 1...X4cS/C 0...X4cR IX-..4(S,(R, Primary Tumor of an Atlanto-Axial Joint Code 1...X4dS/C 0...X4dR IX-..5(S,(R, Primary Tumor of a Paravertebral Muscle Code 1...X4eS/C 0...X4eR IX-..6(S,(R, Primary Tumor of Apidural Fat (e. ., lipoma, Code 1...X4fS/C 0...X4yR IX-..7(S,(R, Primary Tumor of Apidural -essels (e. ., an ioma, Code 1...X4 S/C 0...X4 R IX-..8(S,(R, Primary Tumor of Menin es (e. ., menin ioma, Code 10..X4aS/C 00..X4aR IX-..9(R, Primary Tumor of Spinal Nerves (e. ., neurofibroma, schwannoma, neuroblastoma, Code 00..X4bR IX-.. I O(S,(R, Primary Tumor of Spinal Cord (e. ., lioma, Code 10..X4cS/C 00..X4cR IX-..1 I (S,(R, Metastatic Tumor Affectin a -ertebra Code 1...X4hS/C 0...X4 R IX-..10(S,(R, Metastatic Tumor Affectin the -ertebral Canal Code 1...X4iS/C 0...X4uR IX-..1.(S,(R, Other Infiltratin Neoplastic Disease of a -ertebra (e. ., lymphoma, Code 1...X4(S/C 0...X4qR Cervica Spina or Radicu ar Pain Attributab e to Metabo ic 2one Disease (IX-3) Definition Cervical spinal pain associated with a metabolic bone disease that can reasonably be interpreted as the source of the pain. C inica Features Cervical spinal pain with or without referred pain. Dia.nostic Features Ima in or other evidence of metabolic bone disease affectin the cervical vertebral column, confirmed by appropriate serolo ical or biochemical investi ations and/or histolo ical evidence obtained by needle or other biopsy. Schedu e of Metabo ic 2one Diseases IX-4. I (S,(R, Osteoporosis of A e Code 1.0.X5aS/C 0.0.X5 R IX-4.0(S,(R, Osteoporosis of Dn7nown Cause Code 1.0.X5bS/C 0.0.X5hR IX-4..(S,(R, Osteoporosis of Some Enown Cause Other than A e Code 1.0.X5cS/C 0.0.X5iR IX-4.4(S,(R, Byperparathyroidism Code 1.0.X5dS/C 0.0.X5(R IX-4.5(S,(R, Pa etFs Disease of Bone Code 1.0.X5eS/C 0.0.X57R IX-4.6(S,(R, Metabolic Disease of Bone Not Otherwise Classified Code 1.0.X5fS/C 0.0.X51R Cervica Spina or Radicu ar Pain Attributab e to Arthritis (IX-5) Definition Cervical spinal pain associated with arthritis that can reasonably be interpreted as the source of the pain. C inica Features Cervical spinal pain with or without referred pain. Dia.nostic Features Ima in or other evidence of arthritis affectin the (oints of the cervical vertebral column. Schedu e of Arthritides IX-5. I (S,(R, Rheumatoid Arthritis Code 1.0.X.aS/C 0.0.X.aR IX-5.0(S,(R, An7ylosin Spondylitis Code 1.0.X8aS/C 0.0.X8aR IX-5..(S,(R, Osteoarthritis Code 1.8.X6aS/C 0.8.X6aR IX-5.4(S,(R, Serone ative Spondylarthropathy Not Otherwise Classified Code 10..X8aS/C 0.0.X8aR Remar5s Osteoarthritis is included in this schedule with some hesitation because there is only wea7 evidence that indicates that this condition as dia nosed radiolo ically is causally associated with spinal pain. The alternative classification to 2cervical pain due to osteoarthrosis3 should be 2cervical Gy apophysial (oint pain3 if the criteria for this dia nosis are satisfied (see IX-11, or 2cervical spinal pain of un7nown or uncertain ori in3 (see IX-7,. The condition of 2spondylosis3 is omitted from this schedule because there is no si nificant positive correlation between the radio raphic presence of this condition and the presence of spinal pain (Friedenber and Miller 196.H Beller et al. 198.,. There is no evidence that this condition represents anythin more than a e-chan es in the vertebral column. References Friedenber ZB, Miller IT. De enerative dis7 disease of the cervical spine. J Bone Joint Sur 196.H45A11171J8. Beller CA, Stanley P, Lewis-Jones B, Beller RF. -alue of X-ray examinations of the cervical spine. Br Med J 198.H08711076J9. Cervica Spina or Radicu ar Pain Associated with a Con.enita Vertebra Anoma y (IX-8) Definition Cervical spinal or radicular pain associated with a con enital vertebral anomaly. C inica Features Cervical spinal pain with or without referred pain. Dia.nostic Features Ima in evidence of a con enital vertebral anomaly affectin the cervical vertebral column.