ICD-10 Coding for Disk Herniation(M51.16, M51.26)
Complete ICD-10-CM coding and documentation guide for Disk Herniation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Disk Herniation
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when lumbar disc herniation is confirmed with radiculopathy symptoms. |
|
| M51.26 | Other intervertebral disc displacement, lumbar region | Use when lumbar disc displacement is confirmed without radiculopathy. |
|
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 herniation with radiculopathy
Essential facts and insights about Disk Herniation
Primary ICD-10-CM Codes for disk herniation
Decision Criteria
clinical Criteria
- Presence of radicular pain and MRI confirmation
documentation Criteria
- Detailed description of symptoms and imaging results
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- Cervical disc disorders (M50.-)
Clinical Validation Requirements
- MRI showing nerve root compression
- Positive straight leg raise test
- Dermatomal pain distribution
Code-Specific Risks
- Incorrectly coding without radiculopathy evidence
Coding Notes
- Ensure radiculopathy is documented with clinical findings.
M51.26 - Other intervertebral disc displacement, lumbar region
Use when lumbar disc displacement is confirmed without radiculopathy.
Applicable To
- Lumbar disc bulge without radiculopathy
Excludes
- Disc disorders with radiculopathy (M51.1-)
Clinical Validation Requirements
- Imaging showing disc displacement without nerve compression
Coding Notes
Ensure absence of radiculopathy is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Radiculopathy, lumbar region
M54.16Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Disk Herniation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure imaging reports are included in the patient's record., Verify documentation before coding.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure radiculopathy is documented with clinical tests and imaging.
Impact
Claims for M51.16 without supporting documentation are at risk of audit.
Mitigation Strategy
Ensure thorough documentation of clinical findings and imaging.
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 Disk Herniation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Disk Herniation
Use these documentation templates to ensure complete and accurate documentation for Disk Herniation. These templates include all required elements for proper coding and billing.
Lumbar disc herniation with radiculopathy
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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