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ICD-10 Guide
ICD-10 CodesM47.26

M47.26

Billable

Other spondylosis with radiculopathy, lumbar region

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M47.26 is a billable code used to indicate a diagnosis of other spondylosis with radiculopathy, lumbar region.

Key Diagnostic Point:

M47.26 refers to a condition characterized by degenerative changes in the lumbar spine, specifically spondylosis, which can lead to radiculopathy. Spondylosis is a general term for age-related wear and tear affecting the spinal discs and vertebrae. In the lumbar region, this degeneration can result in nerve root compression, leading to symptoms such as pain, numbness, and weakness in the lower extremities. The condition may arise from various factors, including chronic mechanical stress, genetic predisposition, and previous injuries. Patients may present with a range of symptoms, from mild discomfort to severe pain that limits mobility. Diagnosis typically involves a combination of clinical evaluation, imaging studies such as MRI or CT scans, and nerve conduction studies to assess the extent of nerve involvement. Treatment options may include physical therapy, medications for pain management, and in some cases, surgical intervention to relieve nerve compression. Understanding the nuances of this condition is crucial for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various types of spondylosis and their specific manifestations.
  • Understanding the relationship between spondylosis and radiculopathy.
  • The need for precise documentation of symptoms and diagnostic imaging.
  • Variability in clinical presentation among patients.

Audit Risk Factors

  • Inadequate documentation of radiculopathy symptoms.
  • Failure to specify the level of lumbar involvement.
  • Misclassification of spondylosis type.
  • Lack of imaging studies to support diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes including physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with lower back pain and neurological symptoms, post-surgical follow-ups.

Billing Considerations

Ensure clear documentation of the relationship between spondylosis and radiculopathy.

Neurology

Documentation Requirements

Comprehensive neurological assessments, including reflex testing and sensory evaluations.

Common Clinical Scenarios

Patients with chronic pain and neurological deficits requiring diagnostic testing.

Billing Considerations

Documenting the severity and impact of radiculopathy on daily activities.

Coding Guidelines

Inclusion Criteria

Use M47.26 When
  • According to ICD
  • 10 guidelines, M47
  • 26 should be used when there is clear documentation of spondylosis with radiculopathy specifically in the lumbar region
  • It is important to include details about the patient's symptoms, diagnostic imaging, and any treatments provided

Exclusion Criteria

Do NOT use M47.26 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

63030CPT Code

Laminectomy, lumbar

Clinical Scenario

Performed to relieve nerve root compression due to spondylosis.

Documentation Requirements

Operative report detailing the procedure and indication.

Specialty Considerations

Orthopedic or neurosurgical documentation must clearly link the procedure to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like spondylosis with radiculopathy, improving the accuracy of diagnoses and treatment plans. M47.26 provides a clear distinction from other spinal conditions, facilitating better patient management and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like spondylosis with radiculopathy, improving the accuracy of diagnoses and treatment plans. M47.26 provides a clear distinction from other spinal conditions, facilitating better patient management and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between M47.26 and M54.16?

M47.26 specifically refers to spondylosis with radiculopathy in the lumbar region, while M54.16 is a more general code for radiculopathy in the lumbar region without specifying the underlying cause.