Lumbar Radiculopathy

What ICD-10 codes are used for lumbar radiculopathy?

Lumbar radiculopathy is a condition characterized by the compression or irritation of nerve roots in the lumbar spine. It typically results in pain, numbness, tingling, and weakness that radiate along the path of the affected nerve. This condition frequently affects the sciatic nerve, causing symptoms that extend from the lower back, resulting in chronic low back pain extending to the legs.

The most specific ICD-10-CM code, M54.16, identifies radiculopathy, lumbar region. This code should be used when nerve root compression in the lumbar spine radiates pain and associated symptoms.

Several related conditions may present with similar symptoms or occur alongside lumbar radiculopathy:

• M54.3: Sciatica
• M54.30: Sciatica, unspecified side
• M54.31: Sciatica, right side
• M54.32: Sciatica, left side
• M54.4: Lumbago with sciatica
• M54.40: Lumbago with sciatica, unspecified side
• M54.41: Lumbago with sciatica, right side
• M54.42: Lumbago with sciatica, left side

Intervertebral disc disorders

Lumbar radiculopathy is often secondary to an intervertebral disc disorder. Specific codes include:

• M51.16: Intervertebral disc displacement, lumbar region
• M51.26: Intervertebral disc degeneration, lumbar region
• M51.36: Other intervertebral disc degeneration, lumbar region
• M51.37: Other intervertebral disc degeneration, lumbosacral region

Disc disorders in other spinal regions, such as cervical disc disorder (M50 series), may present with similar symptoms but affect the upper extremities and require different management approaches.

Which lumbar radiculopathy ICD codes are billable? 

Here's a list of the most common ICD codes for lumbar radiculopathy and their billability:

• M54.16: Billable. This code specifies "radiculopathy, lumbar region" and is valid for reimbursement.
• M54.3: Not billable. This code is too general and lacks the specificity required for billing.
• M54.30: Billable. This indicates sciatica with an unspecified side, which is specific enough for billing.
• M54.31: Billable. This code specifies sciatica on the right side.  
• M54.32: Billable as the code specifies sciatica on the left side.  
• M54.4: Not billable. This code is non-specific and cannot be used for billing.
• M54.40: Billable. The code indicates lumbago with sciatica on an unspecified side.
• M54.41: Billable as it specifies lumbago with sciatica on the right side.
• M54.42: Billable because there's a specific diagnosis of lumbago with sciatica located on the left side.

Clinical information

• Lumbar radiculopathy typically presents with radiating pain from the lower back to the lower extremities, characterized by nerve root pain and chronic back pain.
• Common symptoms include paresthesia (tingling/numbness) following dermatomal patterns.
• Patients often experience motor weakness in muscles innervated by affected nerve roots.
• Positive nerve tension signs (straight leg raise test) are frequently observed.
• Accurate diagnosis requires a detailed history of the patient's pain, and a thorough neurological examination is essential for proper assessment.
• Imaging studies (MRI, CT) help identify structural causes affecting the lumbar spine. Electrodiagnostic testing (EMG/NCS) may confirm radiculopathy in uncertain cases.
• Management typically begins with conservative approaches such as physical therapy. Strategies vary based on underlying causes such as other intervertebral disc displacement causes, spinal stenosis, or lumbago with sciatica.
• Medication management is often prescribed for chronic pain and acute low back pain symptoms. Interventional procedures like epidural steroid injections may provide relief for nerve root inflammation.
• Surgical intervention is reserved for refractory cases, especially with progressive neurological deficits.

Synonyms include:

• Lumbar radiculitis
• Lumbar radiculopathy
• Sciatica
• Acute sciatica
• Chronic sciatica
• Medical back problems with major complication and comorbidity
• Medical back problems without major complication and comorbidity