ICD-10 Coding for Lumbar Disc Hernia(M51.16, M51.26)
Complete ICD-10-CM coding and documentation guide for Lumbar Disc Hernia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Disc Hernia
M51.0-M51.9Primary Range
Other intervertebral disc disorders
This range includes codes for lumbar disc herniation with specific conditions like radiculopathy and myelopathy.
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 present 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 Lumbar Disc Hernia
Primary ICD-10-CM Codes for lumbar disc hernia
Decision Criteria
clinical Criteria
- Presence of radicular pain and imaging confirmation of herniation
coding Criteria
- Do not code M54.16 separately if using M51.16
Applicable To
- Herniated lumbar disc with radiculopathy
- Lumbar disc herniation with sciatica
Excludes
- Myelopathy due to disc disorder (M51.06)
Clinical Validation Requirements
- MRI or CT showing disc herniation compressing nerve root
- Positive straight leg raise test
- Neurological deficits such as sensory loss or motor weakness
Code-Specific Risks
- Incorrectly coding radiculopathy separately when it is included in M51.16
Coding Notes
- Ensure documentation specifies radiculopathy linked to disc herniation.
M51.26 - Other intervertebral disc displacement, lumbar region
Use when lumbar disc displacement is present without radiculopathy.
Applicable To
- Lumbar disc displacement without radiculopathy
Excludes
- Radiculopathy due to disc disorder (M51.16)
Clinical Validation Requirements
- Imaging showing disc displacement without nerve root compression
Coding Notes
Ensure documentation clearly states absence of radiculopathy.
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 Lumbar Disc Hernia 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 inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Include size and location of annular defects in post-operative notes.
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use only M51.16 if radiculopathy is due to the herniated disc.
Impact
Using M51.06 for radiculopathy instead of myelopathy.
Mitigation Strategy
Ensure documentation distinguishes between radiculopathy and myelopathy.
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 Lumbar Disc Hernia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Disc Hernia
Use these documentation templates to ensure complete and accurate documentation for Lumbar Disc Hernia. These templates include all required elements for proper coding and billing.
Post-Operative Follow-Up
Specialty: NeurologyRequired Elements
- Patient-reported outcomes
- Neurological exam findings
- Imaging results
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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