ICD-10 Coding for Lumbar Stenosis with Radiculopathy(M48.06, M54.16, M47.26)
Complete ICD-10-CM coding and documentation guide for Lumbar Stenosis 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 Stenosis with Radiculopathy
M48.0-M48.06Primary Range
Spinal stenosis, lumbar region
This range includes codes for spinal stenosis in the lumbar region, which is the primary condition being documented.
Radiculopathy, lumbar region
This range includes codes for radiculopathy, which is often a secondary condition associated with lumbar stenosis.
Spondylosis with radiculopathy
This range is relevant when radiculopathy is due to degenerative spondylosis rather than stenosis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M48.06 | Spinal stenosis, lumbar region | Use when lumbar spinal stenosis is confirmed by imaging and correlates with clinical symptoms. |
|
| M54.16 | Radiculopathy, lumbar region | Use when radiculopathy is present without spondylosis or disc disorders. |
|
| M47.26 | Other spondylosis with radiculopathy, lumbar region | Use when radiculopathy is due to degenerative spondylosis. |
|
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 stenosis with radiculopathy
Essential facts and insights about Lumbar Stenosis with Radiculopathy
Primary ICD-10-CM Codes for lumbar stenosis with radiculopathy
Decision Criteria
clinical Criteria
- Imaging confirms lumbar spinal stenosis with nerve root compression.
coding Criteria
- Exclude spondylosis as the primary cause of radiculopathy.
Applicable To
- Lumbar spinal stenosis
Excludes
- Spondylosis with radiculopathy (M47.26)
Clinical Validation Requirements
- MRI or CT showing lumbar spinal stenosis
- Clinical correlation with symptoms of nerve compression
Code-Specific Risks
- Incorrectly using this code when spondylosis is the primary cause of radiculopathy.
Coding Notes
- Ensure imaging and clinical findings support the diagnosis of lumbar stenosis.
M54.16 - Radiculopathy, lumbar region
Use when radiculopathy is present without spondylosis or disc disorders.
Applicable To
- Lumbar radiculopathy
Excludes
- Disc disorders (M51.1-)
- Spondylosis with radiculopathy (M47.2-)
Clinical Validation Requirements
- Electromyography confirming radiculopathy
- Clinical symptoms consistent with nerve root compression
Coding Notes
Ensure documentation excludes spondylosis and disc disorders.
M47.26 - Other spondylosis with radiculopathy, lumbar region
Use when radiculopathy is due to degenerative spondylosis.
Applicable To
- Spondylosis with radiculopathy
Excludes
- Spinal stenosis without spondylosis (M48.06)
Clinical Validation Requirements
- Imaging showing spondylosis with nerve root compression
- Clinical symptoms consistent with radiculopathy
Coding Notes
Ensure imaging supports spondylosis as the cause of radiculopathy.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Nerve root and plexus compressions in diseases classified elsewhere
G55.3Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other spondylosis with radiculopathy, lumbar region
M47.26Intervertebral disc disorders with radiculopathy, lumbar region
M51.16Spinal stenosis, lumbar region
M48.06Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lumbar Stenosis with Radiculopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M48.06.
Impact
Clinical: Leads to misdiagnosis and inappropriate treatment plans., Regulatory: Fails to meet documentation standards., Financial: Results in claim denials or reduced reimbursement.
Mitigation Strategy
Ensure detailed documentation of imaging findings., Correlate clinical symptoms with imaging results.
Impact
Reimbursement: Incorrect coding can lead to denied claims or incorrect DRG assignment., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data and patient records.
Mitigation Strategy
Use M47.26 when spondylosis is the cause.
Impact
Using M54.16 when spondylosis is present.
Mitigation Strategy
Implement regular training on code differentiation.
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 Stenosis with Radiculopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Stenosis with Radiculopathy
Use these documentation templates to ensure complete and accurate documentation for Lumbar Stenosis with Radiculopathy. These templates include all required elements for proper coding and billing.
Lumbar stenosis with radiculopathy due to spondylosis
Specialty: OrthopedicsRequired Elements
- Imaging findings
- Clinical symptoms
- Exclusion of disc disorders
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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