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ICD-10 Coding for Degeneration of Lumbar Disc(M51.36, M51.37)

Complete ICD-10-CM coding and documentation guide for Degeneration of Lumbar Disc. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Lumbar Disc DegenerationDegenerative Disc Disease of Lumbar Spine

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Related ICD-10 Code Ranges

Complete code families applicable to Degeneration of Lumbar Disc

M51.36-M51.37Primary Range

Degeneration of intervertebral disc, lumbar region

This range covers the primary codes for lumbar disc degeneration, specifying lumbar and lumbosacral regions.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
M51.36Degeneration of intervertebral disc, lumbar regionUse when MRI confirms lumbar disc degeneration with axial or sclerotomal pain.
  • MRI showing Pfirrmann Grade ≥3
  • Loss of disc height ≥50%
  • Modic Type I/II changes
M51.37Degeneration of intervertebral disc, lumbosacral regionUse when degeneration affects the lumbosacral junction with pain extending to the sacral region.
  • Positive seated slump test
  • Documentation of lumbosacral junction involvement

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for lumbar disc degeneration

Essential facts and insights about Degeneration of Lumbar Disc

The ICD-10 code for lumbar disc degeneration is M51.36 for lumbar region and M51.37 for lumbosacral region.

Primary ICD-10-CM Codes for degeneration of lumbar disc

M51.36
Degeneration of intervertebral disc, lumbar region
Non-billable Code

Decision Criteria

clinical Criteria

  • MRI findings of disc degeneration

documentation Criteria

  • Detailed pain description including location and type

Applicable To

  • Discogenic pain
  • Axial back pain

Excludes

Clinical Validation Requirements

  • MRI showing Pfirrmann Grade ≥3
  • Loss of disc height ≥50%
  • Modic Type I/II changes

Code-Specific Risks

  • Incorrectly coding as radiculopathy without EMG confirmation

Coding Notes

  • Ensure MRI findings support the diagnosis of disc degeneration.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Low back pain, unspecified

M54.50
Use when low back pain is present without confirmed disc etiology.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Lumbosacral radiculopathy

M54.41
Use only with confirmed nerve root compression and positive EMG.

Vertebrogenic pain

M54.51
Use for endplate-derived pain with Modic Type I changes.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Degeneration of Lumbar Disc to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.36.

Impact

Clinical: May lead to incorrect diagnosis., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.

Mitigation Strategy

Use specific terms like 'axial' or 'sclerotomal'., Document imaging findings.

Impact

Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with updated coding standards., Data Quality: Inaccurate data reporting and analysis.

Mitigation Strategy

Always use the updated six-digit codes for 2025.

Impact

Using unspecified codes when specific codes are available.

Mitigation Strategy

Regular training on updated coding guidelines.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Degeneration of Lumbar Disc, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Degeneration of Lumbar Disc

Use these documentation templates to ensure complete and accurate documentation for Degeneration of Lumbar Disc. These templates include all required elements for proper coding and billing.

Chronic lumbar disc degeneration with sclerotomal pain

Specialty: Orthopedics

Required Elements

  • Pain characterization
  • Imaging results
  • Exclusion of other causes

Example Documentation

Patient reports axial lumbar pain with referred deep, dull ache along left posterior thigh. MRI confirms L5-S1 disc degeneration.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has chronic back pain. MRI shows disc degeneration.
Good Documentation Example
Patient reports axial lumbar pain (VAS 7/10) with referred deep, dull ache along left posterior thigh (sclerotomal pattern). MRI confirms L5-S1 disc degeneration (Pfirrmann Grade 3).
Explanation
The good example provides specific pain characterization and imaging correlation.

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