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M54.16
ICD-10-CM
Lumbar Radicular Pain

Find information on lumbar radicular pain diagnosis, including clinical documentation, medical coding, and healthcare resources. Learn about ICD-10 codes for lumbar radiculopathy, radicular pain syndrome, and lower back pain with radiculopathy. Explore treatment options, symptoms, and diagnostic criteria for lumbar radicular pain. This resource offers guidance for healthcare professionals on accurate coding and documentation for lumbar spine nerve root compression and related conditions.

Also known as

Sciatica
Lumbar Radiculopathy

Diagnosis Snapshot

Key Facts
  • Definition : Pain radiating along a lumbar nerve root, often to the leg or buttock.
  • Clinical Signs : Numbness, tingling, weakness, pain worsened by movement, coughing, or sneezing.
  • Common Settings : Primary care, spine clinics, pain management, physical therapy.

Related ICD-10 Code Ranges

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

Radiculopathy, lumbar region

Pinched nerve in the lower back causing pain.

M51.-

Other intervertebral disc disorders

Problems with discs in the spine can lead to radicular pain.

G89.2-

Chronic pain due to trauma

Lasting pain from an injury may cause lumbar radicular pain.

M79.1-

Myalgia

Muscle pain in the lumbar region can sometimes mimic radicular pain.

Code-Specific Guidance

Decision Tree for

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

Is the radicular pain due to a herniated disc?

  • Yes

    Site of herniation?

  • No

    Due to spinal stenosis?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Lumbar Radicular Pain
Lumbar Spinal Stenosis
Lumbar Disc Herniation

Documentation Best Practices

Documentation Checklist
  • Lumbar radicular pain diagnosis: ICD-10 code, laterality
  • Symptom onset, duration, quality, radiation
  • Exacerbating and relieving factors documented
  • Neurological exam findings (sensory, motor, reflexes)
  • Impact on ADLs and functional limitations

Coding and Audit Risks

Common Risks
  • Code Specificity

    Using non-specific codes like M54.5 (low back pain) instead of more precise radicular pain codes (M54.1x) impacting reimbursement and data accuracy.

  • Laterality Coding

    Missing laterality modifiers (right, left, bilateral) for M54.1x, leading to claim denials and inaccurate pain representation.

  • Underlying Cause

    Failing to code the underlying cause of radicular pain (e.g., disc herniation) with M54.1x, affecting clinical documentation integrity and quality metrics.

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding (M54.1x) for lumbar radicular pain.
  • Thorough documentation of pain location, radiation, & severity.
  • Assess and document nerve root involvement for CDI compliance.
  • Review EMG/NCS findings to support diagnosis & medical necessity.
  • Correlate exam findings with imaging (MRI) for optimal coding.

Clinical Decision Support

Checklist
  • Verify unilateral leg pain radiating below the knee
  • Confirm sensory/motor deficit matching nerve root
  • Positive straight leg raise or slump test documented
  • Exclude cauda equina syndrome red flags (incontinence)
  • Imaging (MRI lumbar spine) correlates with symptoms

Reimbursement and Quality Metrics

Impact Summary
  • Lumbar Radicular Pain Reimbursement: Coding accuracy impacts payer contracts and medical billing revenue cycle.
  • Quality Metrics Impact: Accurate ICD-10 (M54.1-) coding affects hospital value-based purchasing and reporting.
  • Coding Accuracy Impact: Proper documentation and coding (M54.1x) are crucial for appropriate reimbursement levels.
  • Hospital Reporting Impact: Correct lumbar radicular pain coding influences quality data reporting and public health metrics.

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 M54.1x for lumbar radicular pain
  • Specify laterality: right, left, or bilateral
  • Document radiating pain & nerve root
  • Consider additional codes for cause
  • If due to disc herniation, code M51.1x

Documentation Templates

Patient presents with complaints of lumbar radicular pain, also described as lumbar radiculopathy and sciatica.  Onset of symptoms began approximately [duration] ago and is characterized by radiating pain extending from the lower back down the leg, following the [specify nerve root distribution, e.g., L5 dermatome].  Patient reports the pain as [character of pain, e.g., sharp, burning, shooting] and rates its severity as [pain scale rating] on a 0-10 scale.  Associated symptoms include [list associated symptoms, e.g., numbness, tingling, muscle weakness] in the [affected extremity].  Aggravating factors include [list aggravating factors, e.g., bending, lifting, prolonged sitting], and alleviating factors include [list alleviating factors, e.g., lying down, medication].  Physical examination reveals [objective findings, e.g., positive straight leg raise test, diminished reflexes, decreased sensation].  Differential diagnoses considered include herniated disc, lumbar spinal stenosis, and piriformis syndrome.  Assessment: Lumbar radicular pain likely secondary to [presumptive etiology, e.g., L4-L5 disc herniation].  Plan:  Conservative management initiated with NSAIDs, physical therapy referral for lumbar stabilization exercises, and patient education on proper body mechanics.  Follow-up scheduled in [duration] to assess response to treatment.  Further diagnostic studies, including MRI of the lumbar spine, may be considered if symptoms persist or worsen.  ICD-10 code: [appropriate ICD-10 code, e.g., M54.16].
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