ICD-10 Coding for Low Back Pain with Radiculopathy(M54.16, M51.16)
Complete ICD-10-CM coding and documentation guide for Low Back Pain with Radiculopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Low Back Pain with Radiculopathy
Thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders
Includes disc disorders with radiculopathy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.16 | Radiculopathy, lumbar region | Use when radiculopathy is confirmed without specific disc involvement. |
|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when radiculopathy is directly caused by a disc disorder. |
|
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 low back pain with radiculopathy
Essential facts and insights about Low Back Pain with Radiculopathy
Primary ICD-10-CM Codes for low back pain with radiculopathy
Decision Criteria
clinical Criteria
- Presence of neurological deficits confirmed by imaging or EMG.
Applicable To
- Lumbar radiculopathy
Excludes
- Sciatica without neurological deficits (M54.3-)
Clinical Validation Requirements
- MRI showing nerve root compression
- EMG confirming radiculopathy
- Physical exam with diminished reflexes or sensory loss
Code-Specific Risks
- Incorrectly using for sciatica without neurological deficits
Coding Notes
- Ensure documentation specifies laterality and spinal region.
M51.16 - Intervertebral disc disorders with radiculopathy, lumbar region
Use when radiculopathy is directly caused by a disc disorder.
Applicable To
- Discogenic radiculopathy
Excludes
- Radiculopathy without disc involvement (M54.16)
Clinical Validation Requirements
- MRI showing disc herniation compressing nerve root
- EMG confirming radiculopathy
Coding Notes
Document specific disc level and nerve root affected.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other chronic pain
G89.29Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Low Back Pain with Radiculopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.16.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Include detailed neurological exam in every note.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M54.16 or M51.16 when neurological deficits are present.
Impact
Lack of detailed neurological findings can trigger audits.
Mitigation Strategy
Ensure all exam findings are documented.
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 Low Back Pain with Radiculopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Low Back Pain with Radiculopathy
Use these documentation templates to ensure complete and accurate documentation for Low Back Pain with Radiculopathy. These templates include all required elements for proper coding and billing.
Neurology Progress Note
Specialty: NeurologyRequired Elements
- Subjective symptoms
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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