ICD-10 Coding for Lumbar Degenerative Disc Disease with Radiculopathy(M51.16, M51.362)
Complete ICD-10-CM coding and documentation guide for Lumbar Degenerative Disc Disease with Radiculopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Degenerative Disc Disease with Radiculopathy
M51.1-M51.3Primary Range
Intervertebral disc disorders with radiculopathy and degeneration
This range includes codes for lumbar disc disorders with radiculopathy, which is the primary focus for coding lumbar DDD with radiculopathy.
Radiculopathy
This range includes codes for radiculopathy when the underlying cause is not specified or different from DDD.
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 imaging confirms lumbar disc herniation with radiculopathy symptoms. |
|
| M51.362 | Disc degeneration with both axial back and lower extremity pain | Use when both axial back pain and lower extremity pain are present due to disc degeneration. |
|
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 degenerative disc disease with radiculopathy
Essential facts and insights about Lumbar Degenerative Disc Disease with Radiculopathy
Primary ICD-10-CM Codes for lumbar degenerative disc disease with radiculopathy
Decision Criteria
clinical Criteria
- MRI confirms disc herniation with nerve root compression.
documentation Criteria
- Explicit documentation of DDD causing radiculopathy.
Applicable To
- Lumbar disc herniation with nerve root compression
Clinical Validation Requirements
- MRI showing lumbar disc herniation compressing nerve root
- Positive straight leg raise test
- Dermatomal pain pattern
Code-Specific Risks
- Assuming radiculopathy without imaging confirmation
Coding Notes
- Ensure documentation explicitly links DDD to radiculopathy.
M51.362 - Disc degeneration with both axial back and lower extremity pain
Use when both axial back pain and lower extremity pain are present due to disc degeneration.
Applicable To
- Chronic discogenic low back pain with referred leg pain
Excludes
- Radiculopathy without disc degeneration (M54.16)
Clinical Validation Requirements
- Imaging showing disc degeneration with Modic changes
- Non-dermatomal leg pain
Coding Notes
Ensure pain localization is documented clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other chronic pain
G89.29Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lumbar Degenerative Disc Disease with Radiculopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.
Impact
Clinical: Misrepresentation of the patient's condition, Regulatory: Potential for audit due to incorrect coding, Financial: Loss of reimbursement for specific treatment
Mitigation Strategy
Verify imaging and clinical findings before coding, Ensure documentation specifies discogenic origin
Impact
Reimbursement: Incorrect coding can lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines may result in audits., Data Quality: Inaccurate data entry affects patient records and statistical data.
Mitigation Strategy
Query providers to confirm the relationship between DDD and radiculopathy.
Impact
Using unspecified codes can lead to audits and denied claims.
Mitigation Strategy
Ensure all documentation is specific and supports the chosen codes.
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 Degenerative Disc Disease with Radiculopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Degenerative Disc Disease with Radiculopathy
Use these documentation templates to ensure complete and accurate documentation for Lumbar Degenerative Disc Disease with Radiculopathy. These templates include all required elements for proper coding and billing.
Patient with lumbar DDD and radiculopathy
Specialty: OrthopedicsRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Diagnosis and treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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