ICD-10 Coding for Degenerative Disc Disease of Lumbar Spine(M51.360, M51.361, M51.362)
Complete ICD-10-CM coding and documentation guide for Degenerative Disc Disease of Lumbar Spine. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Degenerative Disc Disease of Lumbar Spine
M51.36-M51.37Primary Range
Degenerative disc disease of lumbar and lumbosacral regions
This range includes codes specific to degenerative disc disease affecting the lumbar and lumbosacral spine, with distinctions based on pain location.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M51.360 | Lumbar DDD with discogenic back pain only | Use when the patient has lumbar DDD with back pain only, without leg pain. |
|
| M51.361 | Lumbar DDD with lower extremity pain only | Use when the patient has lumbar DDD with leg pain only, without back pain. |
|
| M51.362 | Lumbar DDD with both back and leg pain | Use when the patient has lumbar DDD with both back and leg pain. |
|
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 degenerative disc disease of lumbar spine
Essential facts and insights about Degenerative Disc Disease of Lumbar Spine
Primary ICD-10-CM Codes for degenerative disc disease of lumbar spine
Decision Criteria
clinical Criteria
- Presence of axial pain localized to the lumbar spine without leg symptoms.
Applicable To
- Axial pain localized to lumbar spine
Excludes
- Radiculopathy
- Sciatica
Clinical Validation Requirements
- MRI-confirmed Pfirrmann Grade II or higher
- No leg symptoms
Code-Specific Risks
- Incorrectly coding when leg pain is present
Coding Notes
- Ensure documentation specifies 'discogenic back pain' and excludes radicular symptoms.
M51.361 - Lumbar DDD with lower extremity pain only
Use when the patient has lumbar DDD with leg pain only, without back pain.
Applicable To
- Leg pain (non-radicular/sclerotomal) without concurrent back pain
Excludes
- Radiculopathy
- Sciatica
Clinical Validation Requirements
- Provocation discography confirming discogenic origin
- No concurrent back pain
Coding Notes
Ensure documentation specifies 'non-radicular leg pain' and excludes back pain.
M51.362 - Lumbar DDD with both back and leg pain
Use when the patient has lumbar DDD with both back and leg pain.
Applicable To
- Combined axial and non-radicular leg pain
Excludes
- Radiculopathy
- Sciatica
Clinical Validation Requirements
- MRI and discography confirming discogenic pain
- Presence of both back and leg pain
Coding Notes
Ensure documentation specifies both back and leg pain as non-radicular.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain syndrome
G89.29Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Degenerative Disc Disease of Lumbar Spine to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.360.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific terms like 'discogenic back pain'., Include imaging findings in documentation.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Decreased accuracy in clinical data reporting.
Mitigation Strategy
Always use the most specific code available, such as M51.360, M51.361, or M51.362.
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Ensure all documentation supports the most specific code available.
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 Degenerative Disc Disease of Lumbar Spine, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Degenerative Disc Disease of Lumbar Spine
Use these documentation templates to ensure complete and accurate documentation for Degenerative Disc Disease of Lumbar Spine. These templates include all required elements for proper coding and billing.
Chronic lumbar DDD with discogenic pain
Specialty: OrthopedicsRequired Elements
- Pain location and type
- Imaging findings
- Provocation test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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