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M51.27
ICD-10-CM
Lumbosacral Disc Herniation

Find key information on Lumbosacral Disc Herniation including diagnosis codes (ICD-10 M51.1), clinical documentation requirements, healthcare provider resources, and medical coding guidelines. Learn about symptoms, treatment options, and best practices for documenting a Lumbosacral Disc Herniation diagnosis for accurate reimbursement and patient care. This resource provides essential information for physicians, coders, and other healthcare professionals dealing with lower back pain, radiculopathy, and intervertebral disc disorders.

Also known as

Lumbar Disc Herniation
Herniated Disc in Lower Back

Diagnosis Snapshot

Key Facts
  • Definition : A displaced disc in the lower back causing nerve compression.
  • Clinical Signs : Low back pain, leg pain (sciatica), numbness, tingling, weakness.
  • Common Settings : Outpatient clinic, physical therapy, pain management, spine surgery.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M51.27 Coding
M51.1

Lumbosacral disc herniation

Herniated disc in the lower back.

M51.2

Lumbosacral disc displacement

Displaced disc in the lower back, not classified as herniation.

M51.3

Other lumbosacral intervertebral disc degeneration

Degenerative changes in the lower back discs, excluding herniation and displacement.

M54.4

Lumbago with sciatica

Lower back pain that radiates down the leg, often associated with disc herniation.

Code-Specific Guidance

Decision Tree for

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

Is the herniation at L1-L4?

  • Yes

    With myelopathy?

  • No

    Is the herniation at L5-S1?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Lumbosacral disc herniation
Lumbago
Spinal stenosis lumbar

Documentation Best Practices

Documentation Checklist
  • Lumbosacral disc herniation diagnosis code
  • Location and laterality of herniation
  • Symptoms: pain, numbness, weakness
  • Physical exam findings (straight leg raise)
  • Imaging confirmation (MRI, CT)

Coding and Audit Risks

Common Risks
  • Laterality Miscoding

    Incorrect coding for the side of herniation (right, left, or bilateral) can lead to claim denials and inaccurate data.

  • Specificity of Level

    Failing to code the specific lumbosacral level (e.g., L4-L5) impacts reimbursement and quality reporting.

  • Excision vs. Decompression

    Coding a decompression as an excision, or vice-versa, leads to inaccurate severity reflection and potential overpayment.

Mitigation Tips

Best Practices
  • Thorough neurological exam for accurate ICD-10 coding (M51.1)
  • Document pain radiation, sensory/motor deficits for CDI compliance
  • Imaging confirms diagnosis, avoids M54.5 code misdiagnosis
  • Correlate symptoms, exam, imaging for compliant billing, HCC capture
  • Consider MDM complexity for accurate E/M coding (99202-99205)

Clinical Decision Support

Checklist
  • Verify low back pain radiating to leg(s)
  • Confirm positive straight leg raise test
  • Check for neurological deficits (sensory/motor)
  • Review MRI lumbar spine for disc herniation

Reimbursement and Quality Metrics

Impact Summary
  • Lumbosacral Disc Herniation Reimbursement: Coding accuracy impacts Medicare Severity Diagnosis Related Groups (MS-DRG) assignment and hospital payments. Proper ICD-10 coding (M51.x) is crucial for appropriate reimbursement.
  • Quality Metrics Impact: Accurate documentation of pain levels and functional status (Oswestry Disability Index, ODI) influences quality reporting scores and value-based payments.
  • Coding Accuracy Impact: Incorrect laterality coding (left/right) or missing documentation of neurological deficits affects reimbursement and case mix index (CMI).
  • Hospital Reporting Impact: Accurate coding and documentation for lumbosacral disc herniation are critical for public health reporting and research on spine disease prevalence.

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 M51.1 for L5-S1 herniation
  • Verify laterality: Right or Left
  • Document radiculopathy if present
  • Cauda equina? Code M51.17
  • Exclude trauma: Use M51.1X if needed

Documentation Templates

Patient presents with complaints consistent with lumbosacral disc herniation.  Symptoms include low back pain radiating to the leg, described as sciatica or radicular pain.  Onset of pain is reported as [onset timeframe - e.g., gradual, sudden, following lifting incident].  Pain quality is described as [pain quality descriptors - e.g., sharp, burning, aching, electric].  Exacerbating factors include [exacerbating factors - e.g., bending, lifting, sitting, coughing, sneezing].  Alleviating factors include [alleviating factors - e.g., lying down, rest, medication].  Associated symptoms may include numbness, tingling, and weakness in the [affected leg/foot area - e.g., right leg, left foot].  Physical examination reveals [positive or negative] straight leg raise test on the [affected side] at [degrees of elevation], reproducing radicular symptoms.  Neurological examination demonstrates [sensory/motor deficits - e.g., diminished patellar reflex, decreased sensation in dermatome L5].  Differential diagnoses considered include lumbar spinal stenosis, piriformis syndrome, and facet joint pain.  Assessment: Lumbosacral disc herniation at [level - e.g., L4-L5, L5-S1] is suspected.  Plan:  Conservative management is initiated, including NSAIDs for pain relief, physical therapy for core strengthening and lumbar stabilization exercises, and patient education on proper body mechanics.  Imaging studies, such as MRI of the lumbar spine, are ordered to confirm the diagnosis and evaluate the extent of the herniation.  Follow-up appointment scheduled in [timeframe - e.g., two weeks] to assess response to treatment.  Referral to a neurosurgeon or pain management specialist will be considered if symptoms persist or worsen despite conservative measures.
Lumbosacral Disc Herniation - AI-Powered ICD-10 Documentation