ICD-10 Coding for Herniated Disk(M51.16)
Complete ICD-10-CM coding and documentation guide for Herniated Disk. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Herniated Disk
M50-M51Primary Range
Disorders of cervical and other intervertebral discs
This range includes codes for cervical and lumbar disc disorders, including herniation with or without radiculopathy.
Key Information: ICD-10 code for herniated disk with radiculopathy
Essential facts and insights about Herniated Disk
Primary ICD-10-CM Code for herniated disk
Decision Criteria
clinical Criteria
- Presence of lumbar disc herniation with radiculopathy confirmed by imaging
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- M54.16 Radiculopathy, lumbar region
Clinical Validation Requirements
- MRI showing disc herniation at specified level
- Clinical exam confirming radiculopathy
Code-Specific Risks
- Incorrectly using separate codes for herniation and radiculopathy
Coding Notes
- Ensure MRI or clinical exam confirms both herniation and radiculopathy.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Low back pain
M54.5Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Radiculopathy, lumbar region
M54.16Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Herniated Disk to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use standardized templates for documentation., Ensure imaging reports are included in the patient record.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M51.16 for lumbar herniation with radiculopathy.
Impact
Using separate codes for conditions covered by a combination code.
Mitigation Strategy
Educate coding staff on combination code usage.
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 Herniated Disk, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Herniated Disk
Use these documentation templates to ensure complete and accurate documentation for Herniated Disk. These templates include all required elements for proper coding and billing.
Lumbar Herniation with Radiculopathy
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical exam findings
- Imaging results
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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