ICD-10 Coding for Upper Extremity Radiculopathy(M54.12, M50.121)
Complete ICD-10-CM coding and documentation guide for Upper Extremity Radiculopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Upper Extremity Radiculopathy
M54.1-M54.19Primary Range
Radiculopathy
This range includes codes for radiculopathy affecting different regions, with M54.12 specifically for cervical radiculopathy.
Cervical Disc Disorders with Radiculopathy
This range is used when cervical radiculopathy is due to disc disorders, providing more specificity.
Nerve Root and Plexus Disorders
Includes brachial plexus disorders which can mimic or contribute to radiculopathy symptoms.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.12 | Radiculopathy, cervical region | Use when cervical radiculopathy is confirmed without specific disc pathology. |
|
| M50.121 | Cervical disc disorder at C4-C5 level with radiculopathy | Use when MRI confirms disc herniation at C4-C5 causing 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 upper extremity radiculopathy
Essential facts and insights about Upper Extremity Radiculopathy
Primary ICD-10-CM Codes for upper extremity radiculopathy
Decision Criteria
clinical Criteria
- Presence of radicular pain and positive Spurling test
documentation Criteria
- Detailed neurological exam findings
Applicable To
- Cervical radiculopathy
Excludes
- Cervical disc disorders with radiculopathy (M50.1-)
Clinical Validation Requirements
- Positive Spurling test
- Dermatomal sensory loss
- MRI showing nerve root compression
Code-Specific Risks
- Misclassification if disc disorder is present
- Omission of laterality
Coding Notes
- Ensure documentation specifies cervical region and laterality.
M50.121 - Cervical disc disorder at C4-C5 level with radiculopathy
Use when MRI confirms disc herniation at C4-C5 causing radiculopathy.
Applicable To
- C4-C5 disc herniation with radiculopathy
Excludes
- Radiculopathy without disc disorder (M54.12)
Clinical Validation Requirements
- MRI confirming C4-C5 disc herniation
- Radicular symptoms in corresponding dermatome
Coding Notes
Ensure MRI findings are documented to support disc level coding.
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 Upper Extremity Radiculopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.12.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Always specify the affected side in documentation.
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Use M54.12 for cervical radiculopathy with appropriate laterality.
Impact
Risk of audits due to lack of specificity in coding cervical radiculopathy.
Mitigation Strategy
Ensure documentation includes detailed clinical findings and imaging results.
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 Upper Extremity Radiculopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Upper Extremity Radiculopathy
Use these documentation templates to ensure complete and accurate documentation for Upper Extremity Radiculopathy. These templates include all required elements for proper coding and billing.
Cervical Radiculopathy Evaluation
Specialty: NeurologyRequired Elements
- Subjective: Description of pain and aggravating factors
- Objective: Neurological exam findings
- Assessment: Diagnosis with supporting evidence
- Plan: Treatment plan and follow-up
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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