ICD-10 Coding for Degenerative Lumbar Disease(M51.36, M51.37)
Complete ICD-10-CM coding and documentation guide for Degenerative Lumbar Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Degenerative Lumbar Disease
M51.3-M51.9Primary Range
Other intervertebral disc disorders
This range includes codes for degenerative disc disease, specifically affecting the lumbar region.
Dorsalgia and low back pain
These codes are used for documenting associated pain conditions like low back pain and sciatica.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M51.36 | Other intervertebral disc degeneration, lumbar region | Use when MRI confirms lumbar disc degeneration with specific pain localization. |
|
| M51.37 | Other intervertebral disc degeneration, lumbosacral region | Use when MRI confirms lumbosacral disc degeneration with specific pain localization. |
|
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 degenerative lumbar disease
Essential facts and insights about Degenerative Lumbar Disease
Primary ICD-10-CM Codes for degenerative lumbar disease
Decision Criteria
clinical Criteria
- MRI confirms disc degeneration
documentation Criteria
- Pain is specified as discogenic
Applicable To
- Discogenic low back pain
Excludes
- Spondylosis without myelopathy (M47.816)
Clinical Validation Requirements
- MRI showing disc degeneration
- Documented discogenic pain
Code-Specific Risks
- Incorrect use without imaging confirmation
Coding Notes
- Ensure documentation specifies discogenic nature of pain.
M51.37 - Other intervertebral disc degeneration, lumbosacral region
Use when MRI confirms lumbosacral disc degeneration with specific pain localization.
Applicable To
- Lumbosacral disc degeneration
Excludes
- Spondylolisthesis (M43.27)
Clinical Validation Requirements
- MRI showing lumbosacral disc degeneration
- Documented lumbosacral pain
Coding Notes
Ensure documentation specifies lumbosacral nature of pain.
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 Degenerative Lumbar Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.36.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Increases risk of audit and non-compliance., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Always include MRI or X-ray results in documentation., Ensure findings correlate with clinical symptoms.
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Increases risk of audit due to non-compliance with coding guidelines., Data Quality: Decreases data quality and accuracy in patient records.
Mitigation Strategy
Always use the most specific code available, such as M51.362 instead of M51.36.
Impact
Increased scrutiny on unspecified codes in audits.
Mitigation Strategy
Use specific codes with detailed documentation.
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 Degenerative Lumbar Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Degenerative Lumbar Disease
Use these documentation templates to ensure complete and accurate documentation for Degenerative Lumbar Disease. These templates include all required elements for proper coding and billing.
Chronic low back pain with lumbar disc degeneration
Specialty: OrthopedicsRequired Elements
- Patient history
- Pain description
- Imaging findings
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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