ICD-10 Coding for Lumbar Disc Herniation(M51.26, M51.06)
Complete ICD-10-CM coding and documentation guide for Lumbar Disc Herniation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Disc Herniation
M51.0-M51.9Primary Range
Other intervertebral disc disorders
This range includes codes for various disc disorders, including herniation, displacement, and degeneration specific to the lumbar region.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M51.26 | Other intervertebral disc displacement, lumbar region | Use when there is lumbar disc herniation without myelopathy. |
|
| M51.06 | Intervertebral disc disorders with myelopathy, lumbar region | Use when lumbar disc herniation is accompanied by myelopathy. |
|
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 disc herniation
Essential facts and insights about Lumbar Disc Herniation
Primary ICD-10-CM Codes for disc herniation lumbar
Decision Criteria
clinical Criteria
- Presence of lumbar disc herniation without myelopathy
documentation Criteria
- MRI findings and detailed physical exam
Applicable To
- Lumbar disc herniation without myelopathy
Clinical Validation Requirements
- MRI showing ≥3mm disc displacement
- Concordant physical exam findings
Code-Specific Risks
- Confusion with radiculopathy codes
- Incorrect sequencing with ancillary codes
Coding Notes
- Ensure imaging findings support the diagnosis of herniation.
M51.06 - Intervertebral disc disorders with myelopathy, lumbar region
Use when lumbar disc herniation is accompanied by myelopathy.
Applicable To
- Lumbar disc herniation with myelopathy
Excludes
- Radiculopathy without myelopathy (M54.16)
Clinical Validation Requirements
- Myelopathy signs such as hyperreflexia
- Imaging showing spinal cord compression
Coding Notes
Document neurological deficits clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Radiculopathy, lumbar region
M54.16Differential 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 Disc Herniation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.26.
Impact
Clinical: Misrepresentation of the patient's condition., Regulatory: Potential audit risk., Financial: Incorrect billing and potential denials.
Mitigation Strategy
Verify imaging findings., Consult radiology reports.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure clinical documentation specifies neurological findings.
Impact
Confusion between these conditions can lead to incorrect coding.
Mitigation Strategy
Ensure thorough documentation of neurological findings.
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 Disc Herniation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Disc Herniation
Use these documentation templates to ensure complete and accurate documentation for Lumbar Disc Herniation. These templates include all required elements for proper coding and billing.
Lumbar Radiculopathy
Specialty: NeurosurgeryRequired Elements
- Patient history
- Physical exam findings
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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