ICD-10 Coding for Radiculopathy(M54.16, M54.12)
Complete ICD-10-CM coding and documentation guide for Radiculopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Radiculopathy
M54.1-M54.9Primary Range
Other dorsopathies
This range includes codes for radiculopathy and related conditions affecting the spinal nerve roots.
Thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders
This range includes codes for disc disorders that may cause radiculopathy.
Spondylosis
This range includes codes for spondylosis, which can be associated 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 |
|---|---|---|---|
| M54.16 | Lumbar radiculopathy | Use when lumbar radiculopathy is confirmed by clinical and imaging findings. |
|
| M54.12 | Cervical radiculopathy | Use when cervical radiculopathy is confirmed by clinical and imaging findings. |
|
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 radiculopathy
Essential facts and insights about Radiculopathy
Primary ICD-10-CM Codes for radiculopathy
Decision Criteria
clinical Criteria
- Presence of dermatomal pain and sensory loss
documentation Criteria
- Imaging evidence of nerve root compression
Applicable To
- Nerve root compression in lumbar region
Clinical Validation Requirements
- Positive straight-leg raise test
- MRI showing nerve root compression
Code-Specific Risks
- Incorrect use without imaging confirmation
- Failure to specify laterality
Coding Notes
- Ensure documentation supports the use of radiculopathy codes with specific clinical findings.
M54.12 - Cervical radiculopathy
Use when cervical radiculopathy is confirmed by clinical and imaging findings.
Applicable To
- Nerve root compression in cervical region
Excludes
- Disc disorders (M51.0-)
- Spondylosis (M47.1-)
Clinical Validation Requirements
- Spurling’s test positive
- MRI showing cervical nerve root compression
Coding Notes
Ensure documentation supports the use of radiculopathy codes with specific clinical findings.
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 Radiculopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.16.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Increases audit risk., Financial: Potential for claim denials.
Mitigation Strategy
Ensure all imaging findings are documented., Cross-check documentation before submission.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audits and denials., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Always use the most specific code available based on clinical documentation.
Impact
Inaccurate documentation can lead to coding errors.
Mitigation Strategy
Implement regular documentation audits and training.
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 Radiculopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Radiculopathy
Use these documentation templates to ensure complete and accurate documentation for Radiculopathy. These templates include all required elements for proper coding and billing.
Lumbar radiculopathy due to disc herniation
Specialty: NeurologyRequired Elements
- Subjective findings
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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