ICD-10 Coding for Lumbar Spine Spondylosis(M47.896, M47.26)
Complete ICD-10-CM coding and documentation guide for Lumbar Spine Spondylosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Spine Spondylosis
M47.2-M47.9Primary Range
Spondylosis with and without myelopathy or radiculopathy
This range includes codes for lumbar spondylosis with specific conditions like radiculopathy and myelopathy.
Radiculopathy and other dorsopathies
These codes are used for radiculopathy, which often accompanies lumbar spondylosis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M47.896 | Other spondylosis, lumbar region | Use when degenerative changes are present without neurological symptoms. |
|
| M47.26 | Spondylosis with radiculopathy, lumbar region | Use when radiculopathy is confirmed by clinical and imaging findings. |
|
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 spine spondylosis
Essential facts and insights about Lumbar Spine Spondylosis
Primary ICD-10-CM Codes for lumbar spine spondylosis
Decision Criteria
clinical Criteria
- No neurological symptoms present.
documentation Criteria
- Imaging confirms degenerative changes.
Applicable To
- Degenerative changes without myelopathy or radiculopathy
Clinical Validation Requirements
- Imaging showing osteophytes, disc space narrowing, facet hypertrophy
Code-Specific Risks
- Risk of undercoding if neurological symptoms are present but not documented.
Coding Notes
- Ensure imaging and clinical findings support the absence of myelopathy or radiculopathy.
M47.26 - Spondylosis with radiculopathy, lumbar region
Use when radiculopathy is confirmed by clinical and imaging findings.
Applicable To
- Spondylosis with nerve root compression
Excludes
- Spondylosis without myelopathy or radiculopathy (M47.896)
Clinical Validation Requirements
- Dermatomal pain with EMG/NCS confirmation or MRI showing nerve root compression
Coding Notes
Ensure radiculopathy is documented and confirmed by imaging.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lumbar Spine Spondylosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M47.896.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with insurance requirements., Financial: Denial of claims for surgical interventions.
Mitigation Strategy
Ensure all conservative treatments are documented in detail.
Impact
Reimbursement: May result in lower reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on patient conditions.
Mitigation Strategy
Query the provider for clarification on neurological symptoms.
Impact
Failure to document radiculopathy can lead to incorrect coding.
Mitigation Strategy
Ensure thorough documentation of neurological symptoms and imaging.
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 Spine Spondylosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Spine Spondylosis
Use these documentation templates to ensure complete and accurate documentation for Lumbar Spine Spondylosis. These templates include all required elements for proper coding and billing.
Chronic lumbar spondylosis with radiculopathy
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical exam findings
- Imaging results
- Conservative treatment attempts
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Lumbar Spine Spondylosis? Ask your questions below.