ICD-10 Coding for Herniated Nucleus Pulposus Lumbar(M51.16, M51.06)
Complete ICD-10-CM coding and documentation guide for Herniated Nucleus Pulposus Lumbar. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Herniated Nucleus Pulposus Lumbar
M51.0-M51.9Primary Range
Other intervertebral disc disorders
This range includes codes for various intervertebral disc disorders, including lumbar herniated nucleus pulposus.
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 causes radiculopathy. |
|
| M51.06 | Intervertebral disc disorders with myelopathy, lumbar region | Use when lumbar disc herniation causes myelopathy. |
|
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 herniated nucleus pulposus
Essential facts and insights about Herniated Nucleus Pulposus Lumbar
Primary ICD-10-CM Codes for herniated nucleus pulposus lumbar
Decision Criteria
clinical Criteria
- Presence of radicular pain and MRI confirmation
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- M54.5 (Low back pain)
Clinical Validation Requirements
- MRI confirmation of disc herniation
- Radicular pain extending below the knee
- Positive straight leg raise test
Code-Specific Risks
- Incorrect use without radiculopathy documentation
Coding Notes
- Ensure documentation specifies radiculopathy and imaging confirmation.
M51.06 - Intervertebral disc disorders with myelopathy, lumbar region
Use when lumbar disc herniation causes myelopathy.
Applicable To
- Lumbar disc herniation with myelopathy
Excludes
- M54.5 (Low back pain)
Clinical Validation Requirements
- MRI showing spinal cord compression
- Neurological signs like clonus or bowel/bladder dysfunction
Coding Notes
Document specific neurological deficits and imaging findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other chronic pain
G89.29Differential 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 Herniated Nucleus Pulposus Lumbar to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.
Impact
Clinical: Misdiagnosis risk, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always include MRI or CT findings, Ensure imaging supports clinical diagnosis
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M51.16 or M51.06 when HNP is confirmed.
Impact
Failure to document radiculopathy can lead to audit issues.
Mitigation Strategy
Ensure detailed documentation of neurological findings.
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 Nucleus Pulposus Lumbar, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Herniated Nucleus Pulposus Lumbar
Use these documentation templates to ensure complete and accurate documentation for Herniated Nucleus Pulposus Lumbar. These templates include all required elements for proper coding and billing.
Neurosurgery referral for lumbar HNP
Specialty: NeurosurgeryRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Previous treatments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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