ICD-10 Coding for Lumbar Herniated Disc(M51.16, M51.26)
Complete ICD-10-CM coding and documentation guide for Lumbar Herniated Disc. 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
M51.1-M51.9Primary Range
Other intervertebral disc disorders
This range includes codes for various intervertebral disc disorders, including those 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 |
|---|---|---|---|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when both lumbar disc herniation and radiculopathy are documented. |
|
| M51.26 | Other intervertebral disc displacement, lumbar region | Use when lumbar disc displacement is documented 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 herniated disc with radiculopathy
Essential facts and insights about Lumbar Herniated Disc
Primary ICD-10-CM Codes for lumbar herniated disc
Decision Criteria
clinical Criteria
- Presence of radiculopathy confirmed by clinical tests
documentation Criteria
- MRI and EMG findings supporting radiculopathy
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- M54.16 (Radiculopathy, lumbar region)
M51.26 - Other intervertebral disc displacement, lumbar region
Use when lumbar disc displacement is documented without radiculopathy.
Applicable To
- Lumbar disc displacement without radiculopathy
Excludes
- M51.16 (Intervertebral disc disorders with radiculopathy, lumbar region)
Clinical Validation Requirements
- MRI showing disc displacement without nerve root compression
Coding Notes
Ensure radiculopathy is not present when using this code.
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 Herniated Disc to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.
Impact
Clinical: Leads to misdiagnosis or inappropriate treatment., Regulatory: Fails to meet documentation standards., Financial: May result in claim denials or reduced reimbursement.
Mitigation Strategy
Use specific terminology for symptoms and findings, Correlate clinical findings with imaging results
Impact
Reimbursement: May lead to claim denials due to duplicate coding., Compliance: Violates ICD-10 coding guidelines., Data Quality: Results in inaccurate clinical data.
Mitigation Strategy
Use M51.16 alone as it includes radiculopathy.
Impact
Incorrect coding of radiculopathy with disc disorders.
Mitigation Strategy
Use M51.16 only when radiculopathy is confirmed.
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 expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Herniated Disc
Use these documentation templates to ensure complete and accurate documentation for Lumbar Herniated Disc. These templates include all required elements for proper coding and billing.
Lumbar disc herniation with radiculopathy
Specialty: Neurology/NeurosurgeryRequired Elements
- Chief complaint
- History of present illness
- Physical exam findings
- Imaging results
- Special tests
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Lumbar Herniated Disc? Ask your questions below.