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M54.16
ICD-10-CM
Lumbar Pain with Radiculopathy

Find information on lumbar pain with radiculopathy, including clinical documentation tips, medical coding guidelines, and healthcare resources. Learn about ICD-10 codes for lumbar radiculopathy, radicular pain, sciatica, and pinched nerve. Explore effective documentation strategies for lower back pain with nerve root compression, neurological deficits, and sensory or motor dysfunction. This resource helps healthcare professionals accurately document and code lumbar pain with radiculopathy for optimal reimbursement and patient care.

Also known as

Lumbago with Sciatica
Lumbar Radiculopathy

Diagnosis Snapshot

Key Facts
  • Definition : Lower back pain that spreads to the leg, often with numbness or weakness.
  • Clinical Signs : Pain, tingling, numbness, weakness in the leg, limited back movement.
  • Common Settings : Primary care, spine clinics, physical therapy, pain management.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M54.16 Coding
M54.1-

Radiculopathy, lumbar region

Pain radiating along a nerve root in the lower back.

M54.4-

Lumbago with sciatica

Lower back pain with pain radiating down the leg.

M54.5-

Low back pain

Pain localized to the lower back region.

G89.2-

Chronic pain syndrome

Long-lasting pain that may be associated with nerve damage.

Code-Specific Guidance

Decision Tree for

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

Is the radiculopathy due to a herniated disc?

  • Yes

    Is there myelopathy?

  • No

    Is it due to spinal stenosis?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Lumbar Pain with Radiculopathy
Lumbar Spinal Stenosis
Lumbar Disc Displacement

Documentation Best Practices

Documentation Checklist
  • Lumbar pain radiculopathy ICD-10 code
  • Radicular pain location, laterality
  • Sensory/motor deficits documentation
  • Pain quality, radiation details
  • Imaging confirmation, correlation

Coding and Audit Risks

Common Risks
  • Code Specificity

    Using unspecified lumbar pain codes (e.g., M54.9) when documentation supports radiculopathy (e.g., M54.1). Impacts reimbursement and data accuracy.

  • Laterality Documentation

    Missing documentation of affected side (right, left, bilateral) for radiculopathy. Required for accurate coding and proper billing.

  • Supporting Documentation

    Insufficient clinical evidence to support the diagnosis of lumbar radiculopathy, leading to potential denials and compliance issues.

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding (M54.1x) for lumbar radiculopathy
  • Document nerve root & laterality for CDI & compliance
  • Assess pain severity, radiating symptoms & neurological deficits
  • Consider EMG/NCS studies for diagnostic confirmation if indicated
  • Implement evidence-based treatment: PT, medications, injections

Clinical Decision Support

Checklist
  • Verify laterality (left/right/bilateral) documented.
  • Confirm radicular symptoms distribution matches nerve root.
  • Check physical exam for sensory/motor/reflex deficits.
  • Review imaging (MRI/CT) correlating with symptoms.

Reimbursement and Quality Metrics

Impact Summary
  • Lumbar Pain Radiculopathy reimbursement hinges on accurate coding (M54.1x) for optimal claims processing and minimizing denials. Consider medical necessity documentation impact.
  • Coding quality directly impacts lumbar radiculopathy reimbursements. Correct laterality (M54.10-M54.17) and documentation are crucial for appropriate payment.
  • Hospital reporting on lumbar pain with radiculopathy needs specific ICD-10 codes for accurate quality metrics like average length of stay (ALOS) and readmission rates.
  • Physician documentation specificity influences lumbar radiculopathy reimbursement. Clear documentation linking pain, neurological findings, and imaging supports medical necessity.

Streamline Your Medical Coding

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

Quick Tips

Practical Coding Tips
  • Code radicular pain M54.1x
  • Specify nerve root affected
  • Document exam findings, laterality
  • Consider imaging support codes
  • Don't code back pain alone

Documentation Templates

Patient presents with chief complaint of lumbar pain radiating to the leg, consistent with lumbar radiculopathy.  Symptoms include lower back pain, sciatica, radiating pain down the leg, numbness, tingling, and muscle weakness.  Onset of pain was [Date of Onset] and is described as [Character of Pain: e.g., sharp, burning, aching].  Pain is aggravated by [Aggravating Factors: e.g., bending, lifting, sitting] and alleviated by [Alleviating Factors: e.g., rest, ice, heat].  Patient reports [Frequency and Duration of Pain: e.g., constant, intermittent, lasting X minutes/hours].  Physical examination reveals [Objective Findings: e.g., positive straight leg raise test, diminished reflexes, muscle weakness in [Affected Muscle Group], limited range of motion in the lumbar spine].  Neurological examination demonstrates [Specific Neurological Findings: e.g., sensory deficits in [Affected Dermatome], motor deficits in [Affected Myotome]].  Differential diagnosis includes herniated disc, spinal stenosis, degenerative disc disease, and facet joint syndrome.  Assessment is lumbar radiculopathy, likely secondary to [Suspected Etiology: e.g., herniated disc at L4-L5].  Plan includes [Treatment Plan: e.g., conservative management with physical therapy, NSAIDs, referral to pain management, consideration for MRI lumbar spine to confirm diagnosis and rule out other pathologies].  Patient education provided regarding proper body mechanics, activity modification, and pain management strategies.  Follow-up scheduled in [Duration] to assess response to treatment.