ICD-10 Coding for Lumbar Spondylosis(M47.816, M47.26)
Complete ICD-10-CM coding and documentation guide for Lumbar Spondylosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Spondylosis
M47.2-M47.9Primary Range
Other spondylosis with and without myelopathy or radiculopathy
This range includes codes for lumbar spondylosis with specific conditions such as myelopathy and radiculopathy.
Spondylolysis and spondylolisthesis
These codes are used for conditions that may be confused with spondylosis, such as spondylolisthesis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M47.816 | Spondylosis without myelopathy or radiculopathy, lumbar region | Use when documentation specifies lumbar spondylosis without myelopathy or radiculopathy. |
|
| M47.26 | Spondylosis with radiculopathy, lumbar region | Use when documentation specifies lumbar spondylosis with 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 spondylosis without radiculopathy
Essential facts and insights about Lumbar Spondylosis
Primary ICD-10-CM Codes for lumbar spondylosis
Decision Criteria
clinical Criteria
- No neurological deficits present
documentation Criteria
- MRI shows degeneration without nerve compression
Applicable To
- Degenerative disc disease without nerve involvement
Excludes
- Spondylolisthesis (M43.16)
Clinical Validation Requirements
- MRI or CT showing degeneration without nerve compression
- Negative neurological exam
Code-Specific Risks
- Misuse when radiculopathy is present but not documented
Coding Notes
- Ensure documentation clearly states absence of myelopathy or radiculopathy.
M47.26 - Spondylosis with radiculopathy, lumbar region
Use when documentation specifies lumbar spondylosis with radiculopathy.
Applicable To
- Degenerative disc disease with nerve involvement
Excludes
- Spondylolisthesis (M43.16)
Clinical Validation Requirements
- Radicular pain documented
- Positive nerve conduction studies
Coding Notes
Ensure documentation specifies radiculopathy with imaging correlation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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 Spondylosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M47.816.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use specific terms like 'spondylosis without radiculopathy'., Ensure imaging findings support diagnosis.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation explicitly states no radiculopathy.
Impact
Coding M47.816 when radiculopathy is present.
Mitigation Strategy
Verify documentation for radicular symptoms and imaging before coding.
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 Spondylosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Spondylosis
Use these documentation templates to ensure complete and accurate documentation for Lumbar Spondylosis. These templates include all required elements for proper coding and billing.
Lumbar Spondylosis without Radiculopathy
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Lumbar Spondylosis? Ask your questions below.