ICD-10 Coding for Herniated Lumbar Disc(M51.16, M51.26)
Complete ICD-10-CM coding and documentation guide for Herniated Lumbar Disc. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Herniated Lumbar Disc
M51.1-M51.3Primary Range
Thoracic, lumbar, and lumbosacral intervertebral disc disorders
This range includes codes for disc disorders with radiculopathy and other disc displacements, which are primary for herniated lumbar disc.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when a lumbar disc herniation is confirmed with radiculopathy. |
|
| M51.26 | Other intervertebral disc displacement, lumbar region | Use when disc displacement is present without radiculopathy or 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 herniated lumbar disc with radiculopathy
Essential facts and insights about Herniated Lumbar Disc
Primary ICD-10-CM Codes for herniated lumbar disc
Decision Criteria
clinical Criteria
- Presence of radiculopathy confirmed by imaging and clinical exam
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- Myelopathy (M51.06)
Clinical Validation Requirements
- MRI showing nerve root compression
- Neurological deficits such as dermatomal pain or weakness
Code-Specific Risks
- Confusing radiculopathy with myelopathy
Coding Notes
- Ensure documentation specifies radiculopathy to avoid using non-specific codes.
M51.26 - Other intervertebral disc displacement, lumbar region
Use when disc displacement is present without radiculopathy or myelopathy.
Applicable To
- Asymptomatic lumbar disc displacement
Excludes
- Radiculopathy (M51.16)
Clinical Validation Requirements
- Imaging showing disc displacement without nerve compression
Coding Notes
Ensure imaging confirms displacement without neurological impact.
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 Herniated Lumbar Disc to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.
Impact
Clinical: Leads to inadequate treatment plans., Regulatory: Increases risk of audit failures., Financial: Results in lower reimbursement rates.
Mitigation Strategy
Ensure detailed clinical documentation, Use specific codes when possible
Impact
Reimbursement: Incorrect coding can lead to reduced reimbursement., Compliance: May result in compliance issues during audits., Data Quality: Affects accuracy of clinical data.
Mitigation Strategy
Verify clinical documentation for specific neurological symptoms.
Impact
High denial rates for M51.16 without proper documentation.
Mitigation Strategy
Ensure all documentation supports the presence of radiculopathy.
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 Herniated Lumbar Disc, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Herniated Lumbar Disc
Use these documentation templates to ensure complete and accurate documentation for Herniated Lumbar Disc. These templates include all required elements for proper coding and billing.
Lumbar disc herniation with radiculopathy
Specialty: NeurosurgeryRequired Elements
- Imaging results
- Neurological exam findings
- Patient symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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