ICD-10 Coding for Spondylosis of Lumbar Spine(M47.16, M47.26, M47.816)
Complete ICD-10-CM coding and documentation guide for Spondylosis of Lumbar Spine. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Spondylosis of Lumbar Spine
M47.2-M47.9Primary Range
Other spondylosis
This range includes codes for spondylosis with and without myelopathy or 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 |
|---|---|---|---|
| M47.16 | Spondylosis with myelopathy, lumbar region | Use when there is evidence of myelopathy in the lumbar region due to spondylosis. |
|
| M47.26 | Spondylosis with radiculopathy, lumbar region | Use when radiculopathy is present due to spondylosis without myelopathy. |
|
| M47.816 | Spondylosis without myelopathy or radiculopathy, lumbar region | Use when spondylosis is present without neurological symptoms. |
|
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 with myelopathy
Essential facts and insights about Spondylosis of Lumbar Spine
Primary ICD-10-CM Codes for spondylosis of lumbar spine
Decision Criteria
clinical Criteria
- Presence of myelopathy confirmed by imaging
Applicable To
- Myelopathy due to spondylosis
Excludes
- Spondylosis without myelopathy or radiculopathy (M47.816)
Clinical Validation Requirements
- MRI showing spinal cord compression
- Neurological deficits such as weakness or sensory loss
Code-Specific Risks
- Misdiagnosing myelopathy without proper imaging confirmation
Coding Notes
- Ensure documentation specifies myelopathy and correlates with imaging findings.
M47.26 - Spondylosis with radiculopathy, lumbar region
Use when radiculopathy is present due to spondylosis without myelopathy.
Applicable To
- Radiculopathy due to spondylosis
Excludes
- Spondylosis with myelopathy (M47.16)
Clinical Validation Requirements
- MRI showing nerve root compression
- Clinical signs of radiculopathy such as dermatomal pain
Coding Notes
Documentation must clearly link radiculopathy to spondylosis.
M47.816 - Spondylosis without myelopathy or radiculopathy, lumbar region
Use when spondylosis is present without neurological symptoms.
Applicable To
- Degenerative changes without neurological involvement
Excludes
- Spondylosis with myelopathy (M47.16)
- Spondylosis with radiculopathy (M47.26)
Clinical Validation Requirements
- Imaging showing degenerative changes without nerve involvement
Coding Notes
Ensure documentation supports absence of neurological symptoms.
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 Spondylosis of Lumbar Spine to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M47.16.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Always include imaging results in the patient's record., Cross-check documentation with radiology reports.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on patient conditions.
Mitigation Strategy
Ensure documentation specifies spondylosis and correlates with imaging findings.
Impact
Lack of detailed neurological findings in records.
Mitigation Strategy
Implement checklist for neurological exams in patients with spondylosis.
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 Spondylosis of Lumbar Spine, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Spondylosis of Lumbar Spine
Use these documentation templates to ensure complete and accurate documentation for Spondylosis of Lumbar Spine. These templates include all required elements for proper coding and billing.
Spondylosis with radiculopathy
Specialty: OrthopedicsRequired Elements
- Pain characterization
- Neurological findings
- Imaging correlation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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