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M54.17
ICD-10-CM
Low Back Pain with Radiculopathy

Find information on Low Back Pain with Radiculopathy including clinical documentation, medical coding, ICD-10 codes, diagnosis codes, treatment, and prognosis. Learn about radicular pain, nerve root compression, lumbar radiculopathy symptoms, and sciatica related to low back pain. This resource offers guidance for healthcare professionals on accurate coding and documentation for Low Back Pain with Radiculopathy. Explore resources related to differential diagnosis and evidence-based management of this condition.

Also known as

Lumbar Radiculopathy
Lumbosacral Radiculopathy
Sciatica with Neurological Deficits

Diagnosis Snapshot

Key Facts
  • Definition : Nerve pain in the low back, often radiating to leg(s), caused by compressed spinal nerves.
  • Clinical Signs : Low back pain, leg pain (sciatica), numbness, tingling, weakness, reflex changes.
  • Common Settings : Primary care, spine clinics, pain management, physical therapy, orthopedics.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M54.17 Coding
M54.10-M54.19

Radiculopathy, lumbar region

Low back pain caused by pinched nerves.

M54.40-M54.49

Lumbar spinal stenosis

Narrowing of the spinal canal causing back and leg pain.

M51.20-M51.29

Lumbosacral spondylosis

Degenerative changes in the lower spine causing pain.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the low back pain with radiculopathy due to a traumatic injury?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Low Back Pain with Radiculopathy
Lumbar Spinal Stenosis
Lumbar Disc Herniation

Documentation Best Practices

Documentation Checklist
  • Low back pain with radiculopathy ICD-10 code
  • Radicular pain laterality (left/right)
  • Sensory/motor deficits documentation
  • Pain radiation dermatome affected
  • Cauda equina symptoms ruled out

Coding and Audit Risks

Common Risks
  • Code Specificity

    Lack of documentation specifying laterality (right, left, bilateral) and the affected nerve root for accurate M54.1x code selection.

  • Radiculopathy Proof

    Insufficient clinical evidence in documentation to support radiculopathy diagnosis, leading to potential upcoding from M54.5 (low back pain).

  • Causation Clarity

    Unclear documentation linking low back pain with the identified radiculopathy, impacting accurate code assignment and reimbursement.

Mitigation Tips

Best Practices
  • Document radicular symptoms, not just back pain. ICD-10: M54.1
  • Specify nerve root & laterality. Improve CDI for accurate coding.
  • EMG/NCS if needed: Supports diagnosis & justifies interventions.
  • Correlate imaging with exam findings for medical necessity compliance.
  • Clearly document response to conservative therapy for HCC coding.

Clinical Decision Support

Checklist
  • Verify radicular pain symptoms: dermatomal distribution, numbness, tingling
  • Confirm neurological deficits: weakness, reflex changes in affected limb
  • Imaging (MRI preferred) correlates with exam findings: nerve root compression
  • Assess for red flags: cauda equina, infection, malignancy

Reimbursement and Quality Metrics

Impact Summary
  • Low Back Pain with Radiculopathy reimbursement hinges on accurate ICD-10 (M54.1-) and CPT coding for procedures like MRIs, injections, and physical therapy. Proper documentation impacts payer contracts and claim denials.
  • Coding quality directly affects Case Mix Index (CMI) for Low Back Pain with Radiculopathy, impacting hospital reimbursement and resource allocation. Accurate coding reflects patient complexity and justifies higher payments.
  • Timely and specific documentation of radiculopathy symptoms (e.g., pain, numbness, weakness) is crucial for supporting medical necessity of interventions and reducing audit risks related to Low Back Pain.
  • Hospital quality reporting for Low Back Pain with Radiculopathy relies on accurate diagnosis and procedure codes. Data impacts public rankings, pay-for-performance programs, and value-based care initiatives.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code radicular pain M54.1
  • Specify nerve root affected
  • Document exam findings, laterality
  • Consider imaging support
  • Link to underlying cause if known

Documentation Templates

Patient presents with complaints of low back pain radiating to the leg, consistent with lumbar radiculopathy.  Onset of symptoms occurred approximately [duration] ago and is described as [quality of pain: e.g., sharp, burning, aching, electric].  The pain is exacerbated by [exacerbating factors: e.g., bending, lifting, sitting, standing] and relieved by [relieving factors: e.g., rest, medication, ice, heat].  The patient reports pain radiating down the [affected leg: right, left] along the [dermatomal distribution: e.g., L5, S1] dermatome.  Associated symptoms include [associated symptoms: e.g., numbness, tingling, weakness, muscle spasms].  Physical examination reveals [positive findings: e.g., positive straight leg raise test, decreased reflexes, muscle weakness, sensory deficits].  Neurological examination indicates [neurological findings: e.g., diminished reflexes, dermatomal sensory loss].  The patient denies [pertinent negatives: e.g., bowel or bladder incontinence, saddle anesthesia].  Differential diagnoses include lumbar disc herniation, spinal stenosis, degenerative disc disease, and facet joint syndrome.  Assessment points to low back pain with radiculopathy, likely secondary to [suspected etiology: e.g., disc herniation].  Plan includes [diagnostic testing: e.g., MRI lumbar spine], [pharmacological treatment: e.g., NSAIDs, muscle relaxants, neuropathic pain medication], [physical therapy: e.g., core strengthening exercises, stretching], and [referral if necessary: e.g., referral to pain management specialist, neurosurgery].  Patient education provided on proper body mechanics, activity modification, and pain management strategies. Follow-up scheduled in [duration] to assess response to treatment.