ICD-10 Coding for Lumbar Radiculitis(M54.16, M51.16)
Complete ICD-10-CM coding and documentation guide for Lumbar Radiculitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Radiculitis
M54.1-M54.9Primary Range
Other dorsopathies
This range includes codes for radiculopathy and sciatica, which are directly related to lumbar radiculitis.
Thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders
This range includes disc disorders with radiculopathy, often a cause of lumbar radiculitis.
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 lumbar nerve root compression is confirmed with radicular symptoms. |
|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when radiculopathy is due to a lumbar 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 lumbar radiculitis
Essential facts and insights about Lumbar Radiculitis
Primary ICD-10-CM Codes for lumbar radiculitis
Decision Criteria
clinical Criteria
- Confirmed lumbar nerve root compression with radicular symptoms
Applicable To
- Lumbar radiculitis
- Lumbar nerve root disorder
Clinical Validation Requirements
- Imaging showing nerve root compression
- Positive straight leg raise test
- Dermatomal sensory loss
Code-Specific Risks
- Incorrectly using for non-specific back pain
Coding Notes
- Ensure documentation specifies laterality and cause if applicable.
M51.16 - Intervertebral disc disorders with radiculopathy, lumbar region
Use when radiculopathy is due to a lumbar disc disorder.
Applicable To
- Lumbar disc disorder with radiculopathy
Excludes
- M54.16 (Radiculopathy, lumbar region)
Clinical Validation Requirements
- MRI showing disc herniation compressing nerve root
Coding Notes
Document the specific disc and nerve root involved.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lumbar Radiculitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.16.
Impact
Clinical: Inaccurate clinical records, Regulatory: Potential audit issues, Financial: Delayed or denied claims
Mitigation Strategy
Always document the affected side, Use templates to ensure completeness
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Replace M54.5 with M54.16 if documentation includes 'radiating pain with neurological deficits'.
Impact
Failure to document laterality can lead to audit flags.
Mitigation Strategy
Use standardized templates that prompt for laterality.
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 Radiculitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Radiculitis
Use these documentation templates to ensure complete and accurate documentation for Lumbar Radiculitis. These templates include all required elements for proper coding and billing.
Neurology Progress Note
Specialty: NeurologyRequired Elements
- Assessment
- Imaging findings
- EMG results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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