ICD-10 Coding for Lumbar Foraminal Stenosis(M48.061, M48.062, M99.63)
Complete ICD-10-CM coding and documentation guide for Lumbar Foraminal Stenosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Foraminal Stenosis
M48.0-M48.06Primary Range
Spinal stenosis, lumbar region
This range covers spinal stenosis specific to the lumbar region, including foraminal stenosis.
Disorders of the spine, neural foraminal stenosis
Used when the etiology of foraminal stenosis is unspecified or isolated.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M48.061 | Spinal stenosis, lumbar region without neurogenic claudication | Use when lumbar stenosis is present without neurogenic claudication symptoms. |
|
| M48.062 | Spinal stenosis, lumbar region with neurogenic claudication | Use when lumbar stenosis is present with neurogenic claudication symptoms. |
|
| M99.63 | Disorders of the spine, neural foraminal stenosis | Use when foraminal stenosis is isolated and etiology is unspecified. |
|
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 foraminal stenosis
Essential facts and insights about Lumbar Foraminal Stenosis
Primary ICD-10-CM Codes for lumbar foraminal stenosis
Decision Criteria
clinical Criteria
- No neurogenic claudication symptoms
Applicable To
- Lumbar spinal stenosis without claudication
Excludes
- Spinal stenosis with neurogenic claudication (M48.062)
Clinical Validation Requirements
- MRI showing lumbar stenosis without nerve root compression
- Absence of neurogenic claudication symptoms
Code-Specific Risks
- Misclassification if claudication symptoms are present
Coding Notes
- Ensure documentation specifies absence of claudication.
M48.062 - Spinal stenosis, lumbar region with neurogenic claudication
Use when lumbar stenosis is present with neurogenic claudication symptoms.
Applicable To
- Lumbar spinal stenosis with claudication
Excludes
- Spinal stenosis without neurogenic claudication (M48.061)
Clinical Validation Requirements
- MRI showing lumbar stenosis with nerve root compression
- Presence of neurogenic claudication symptoms
Coding Notes
Ensure documentation specifies presence of claudication.
M99.63 - Disorders of the spine, neural foraminal stenosis
Use when foraminal stenosis is isolated and etiology is unspecified.
Applicable To
- Isolated foraminal stenosis
Excludes
- Spinal stenosis with or without neurogenic claudication (M48.061, M48.062)
Clinical Validation Requirements
- MRI showing isolated foraminal narrowing
Coding Notes
Use only when no other specific etiology is documented.
Differential 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 Foraminal Stenosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M48.061.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always document specific side (left/right), Use templates to ensure completeness
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M48.061 or M48.062 based on presence of claudication.
Impact
Failure to sequence underlying etiology before stenosis code.
Mitigation Strategy
Review coding guidelines and ensure proper sequencing.
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 Foraminal Stenosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Foraminal Stenosis
Use these documentation templates to ensure complete and accurate documentation for Lumbar Foraminal Stenosis. These templates include all required elements for proper coding and billing.
Lumbar stenosis with neurogenic claudication
Specialty: NeurosurgeryRequired Elements
- Anatomical specificity
- Presence of claudication
- Underlying etiology
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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