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ICD-10 Coding for Lumbar Disk Herniation(M51.16, M51.17)

Complete ICD-10-CM coding and documentation guide for Lumbar Disk Herniation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Herniated Lumbar DiscSlipped DiscRuptured Disc

Related ICD-10 Code Ranges

Complete code families applicable to Lumbar Disk Herniation

M51.0-M51.9Primary Range

Other intervertebral disc disorders

This range includes specific codes for lumbar disc herniation with and without myelopathy.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
M51.16Intervertebral disc disorders with radiculopathy, lumbar regionUse when lumbar disc herniation is confirmed with radiculopathy symptoms.
  • MRI confirmation of disc herniation
  • Radicular pain pattern
  • Positive straight leg raise test
M51.17Intervertebral disc disorders with myelopathy, lumbar regionUse when lumbar disc herniation causes myelopathy.
  • MRI showing spinal cord compression
  • Symptoms of myelopathy such as bowel/bladder dysfunction

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 disk herniation

Essential facts and insights about Lumbar Disk Herniation

The ICD-10 code for lumbar disk herniation with radiculopathy is M51.16, and with myelopathy is M51.17.

Primary ICD-10-CM Codes for lumbar disk herniation

Intervertebral disc disorders with radiculopathy, lumbar region
Billable Code

Decision Criteria

clinical Criteria

  • Presence of radicular pain and imaging confirmation

Applicable To

  • Herniated lumbar disc with radiculopathy

Excludes

  • Cervical disc disorders (M50.-)
  • Thoracic disc disorders (M51.2-)

Clinical Validation Requirements

  • MRI confirmation of disc herniation
  • Radicular pain pattern
  • Positive straight leg raise test

Code-Specific Risks

  • Misclassification as general low back pain

Coding Notes

  • Ensure documentation specifies radiculopathy and imaging findings.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Other chronic pain

G89.29
Use when chronic pain management is a focus.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Low back pain

M54.5
Use M54.5 when herniation is not confirmed.

Intervertebral disc disorders with radiculopathy, lumbar region

M51.16
Use M51.16 when myelopathy is not present.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Lumbar Disk Herniation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.16.

Impact

Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.

Mitigation Strategy

Always include imaging results in documentation.

Impact

Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Use M51.16 or M51.17 based on clinical findings.

Impact

Using non-specific codes for lumbar disc herniation.

Mitigation Strategy

Ensure detailed documentation and correct code selection.

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 Disk Herniation, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Lumbar Disk Herniation

Use these documentation templates to ensure complete and accurate documentation for Lumbar Disk Herniation. These templates include all required elements for proper coding and billing.

Initial Evaluation of Lumbar Disc Herniation

Specialty: Orthopedics

Required Elements

  • Pain description
  • Neurological deficits
  • Imaging findings

Example Documentation

Patient presents with severe right L5 radicular pain, positive SLR, MRI confirms L4-L5 disc extrusion.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Low back pain with leg radiation.
Good Documentation Example
Severe right L5 radicular pain, positive SLR, MRI confirms L4-L5 disc extrusion.
Explanation
The good example includes specific symptoms, test results, and imaging confirmation.

Need help with ICD-10 coding for Lumbar Disk Herniation? Ask your questions below.

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