ICD-10 Coding for Lumbar Herniated Disc with Radiculopathy(M51.16)
Complete ICD-10-CM coding and documentation guide for Lumbar Herniated Disc with Radiculopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Herniated Disc with Radiculopathy
M51-M54Primary Range
Other Dorsopathies
This range includes codes for disc disorders and related conditions affecting the spine, including radiculopathy.
Key Information: ICD-10 code for lumbar herniated disc with radiculopathy
Essential facts and insights about Lumbar Herniated Disc with Radiculopathy
Primary ICD-10-CM Code for lumbar herniated disc with radiculopathy
Decision Criteria
clinical Criteria
- MRI confirms disc herniation with nerve root compression.
documentation Criteria
- Documented neurological deficits consistent with radiculopathy.
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- Myelopathy (M47.16)
Clinical Validation Requirements
- MRI showing disc herniation compressing nerve root
- Physical exam with dermatomal sensory loss and reflex changes
Code-Specific Risks
- Incorrectly using without imaging confirmation
- Confusing with sciatica without disc etiology
Coding Notes
- Ensure documentation specifies radiculopathy due to disc herniation.
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 Lumbar Herniated Disc with Radiculopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.
Impact
Clinical: Misrepresentation of the patient's condition., Regulatory: Potential audit issues., Financial: Possible claim denials.
Mitigation Strategy
Verify imaging results before coding., Ensure documentation specifies disc involvement.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure MRI or CT imaging confirms disc herniation.
Impact
Lack of imaging confirmation for disc herniation.
Mitigation Strategy
Ensure all claims include imaging reports.
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 Herniated Disc with Radiculopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Herniated Disc with Radiculopathy
Use these documentation templates to ensure complete and accurate documentation for Lumbar Herniated Disc with Radiculopathy. These templates include all required elements for proper coding and billing.
Patient with lumbar radiculopathy due to herniated disc
Specialty: NeurologyRequired Elements
- Patient history of radicular pain
- Imaging results confirming disc herniation
- Physical exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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