ICD-10 Coding for Lumbar Radicular Pain(M54.16, M51.16)
Complete ICD-10-CM coding and documentation guide for Lumbar Radicular Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Radicular Pain
M54.1-M54.4Primary Range
Dorsalgia codes related to radiculopathy and sciatica
This range includes codes for lumbar radiculopathy and sciatica, which are primary for lumbar radicular pain.
Intervertebral disc disorders with radiculopathy
This range is relevant when lumbar radicular pain is due to disc disorders.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.16 | Radiculopathy, lumbar region | Use when there is confirmed lumbar nerve root involvement with radicular symptoms. |
|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when lumbar radicular pain is due to disc disorders. |
|
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 radicular pain
Essential facts and insights about Lumbar Radicular Pain
Primary ICD-10-CM Codes for lumbar radicular pain
Decision Criteria
clinical Criteria
- Presence of radicular pain in a dermatomal pattern
documentation Criteria
- Imaging confirmation of nerve root compression
Applicable To
- Lumbar radiculopathy
Excludes
- Cervical radiculopathy (M54.12)
Clinical Validation Requirements
- MRI showing nerve root compression
- Positive straight leg raise test
Code-Specific Risks
- Misclassification as general low back pain
Coding Notes
- Ensure documentation specifies radicular symptoms and imaging findings.
M51.16 - Intervertebral disc disorders with radiculopathy, lumbar region
Use when lumbar radicular pain is due to disc disorders.
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- Cervical disc disorders with radiculopathy (M50.1-)
Clinical Validation Requirements
- MRI showing disc herniation
- EMG confirming radiculopathy
Coding Notes
Document disc disorder and radiculopathy symptoms clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Low back pain
M54.5Differential 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 Radicular Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.16.
Impact
Clinical: Leads to misdiagnosis and inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific terminology for radicular symptoms, Ensure imaging findings are documented
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies radiculopathy to use M54.16.
Impact
Risk of audits due to incorrect coding of lumbar radiculopathy as general back pain.
Mitigation Strategy
Ensure detailed documentation of radicular symptoms and imaging 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 Radicular Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Radicular Pain
Use these documentation templates to ensure complete and accurate documentation for Lumbar Radicular Pain. These templates include all required elements for proper coding and billing.
Neurosurgery Consultation
Specialty: NeurosurgeryRequired Elements
- Pain characteristics
- Objective findings
- Imaging correlation
- Conservative care failure
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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