ICD-10 Coding for Lumbosacral Disc Herniation(M51.26, M51.06)
Complete ICD-10-CM coding and documentation guide for Lumbosacral Disc Herniation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbosacral Disc Herniation
M51.0-M51.9Primary Range
Other intervertebral disc disorders
This range includes specific codes for lumbar disc herniation with and without myelopathy.
Dorsalgia
Includes codes for back pain and radiculopathy, often used in conjunction with herniation codes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M51.26 | Other intervertebral disc displacement, lumbar region | Use when MRI confirms lumbar disc herniation without spinal cord involvement. |
|
| M51.06 | Intervertebral disc disorders with myelopathy, lumbar region | Use when there is evidence of spinal cord compression due to herniation. |
|
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 lumbosacral disc herniation
Essential facts and insights about Lumbosacral Disc Herniation
Primary ICD-10-CM Codes for lumbosacral disc herniation
Decision Criteria
clinical Criteria
- Presence of lumbar disc herniation confirmed by imaging
documentation Criteria
- Detailed documentation of the affected lumbar level and symptoms
Applicable To
- Lumbar disc herniation without myelopathy
Excludes
- M51.06 - Intervertebral disc disorders with myelopathy, lumbar region
M51.06 - Intervertebral disc disorders with myelopathy, lumbar region
Use when there is evidence of spinal cord compression due to herniation.
Applicable To
- Lumbar disc herniation with myelopathy
Excludes
- M51.26 - Other intervertebral disc displacement, lumbar region
Clinical Validation Requirements
- MRI showing spinal cord compression
- Symptoms of myelopathy such as weakness or bowel/bladder dysfunction
Coding Notes
Prioritize M51.06 over radiculopathy codes if myelopathy is present.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Intervertebral annulus fibrosus defect, lumbosacral region, unspecified size
M51.A3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lumbosacral Disc Herniation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M51.26.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Increased risk of audits., Financial: Potential for denied claims.
Mitigation Strategy
Use specific codes based on imaging and clinical findings.
Impact
Reimbursement: Incorrect billing can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation in patient records.
Mitigation Strategy
Use comprehensive codes like 63047 for combined procedures.
Impact
Risk of audits due to non-specific coding.
Mitigation Strategy
Ensure detailed documentation supports 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 Lumbosacral Disc Herniation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbosacral Disc Herniation
Use these documentation templates to ensure complete and accurate documentation for Lumbosacral Disc Herniation. These templates include all required elements for proper coding and billing.
Lumbar disc herniation with radiculopathy
Specialty: NeurosurgeryRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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