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ICD-10 Guide
ICD-10 CodesM54.12

M54.12

Billable

Radiculopathy, cervical region

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

Code Description

ICD-10 M54.12 is a billable code used to indicate a diagnosis of radiculopathy, cervical region.

Key Diagnostic Point:

Radiculopathy in the cervical region refers to a condition where nerve roots in the cervical spine are compressed or irritated, leading to pain, weakness, or numbness that radiates into the upper extremities. This condition is often associated with cervical disc herniation, degenerative disc disease, or cervical spondylosis. Patients may present with symptoms such as neck pain, shoulder pain, and radiating pain down the arms, often described as a sharp or burning sensation. Dorsalgia, or back pain, may also be present, complicating the clinical picture. Conservative management typically includes physical therapy, pain management with NSAIDs, and corticosteroid injections. In cases where conservative treatment fails, surgical options such as discectomy or spinal fusion may be considered to relieve nerve compression. Accurate diagnosis and management are crucial, as the symptoms can mimic other conditions such as sciatica or thoracic outlet syndrome.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between radiculopathy and other types of pain syndromes.
  • Understanding the specific cervical nerve root involved.
  • Variability in symptoms and their presentation.
  • Documentation of conservative vs surgical management.

Audit Risk Factors

  • Inadequate documentation of symptoms and their severity.
  • Failure to document conservative management attempts.
  • Misidentification of the affected nerve root.
  • Inconsistent coding of related conditions.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with neck pain and radicular symptoms, post-surgical follow-ups.

Billing Considerations

Ensure documentation reflects the neurological deficits and response to treatment.

Orthopedic Surgery

Documentation Requirements

Surgical notes, pre-operative assessments, and post-operative care documentation.

Common Clinical Scenarios

Patients requiring surgical intervention for cervical radiculopathy.

Billing Considerations

Document the rationale for surgical intervention and outcomes.

Coding Guidelines

Inclusion Criteria

Use M54.12 When
  • Follow ICD
  • CM guidelines for coding radiculopathy, ensuring accurate documentation of the affected nerve root and any associated conditions
  • Include details on the severity and duration of symptoms

Exclusion Criteria

Do NOT use M54.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

63075CPT Code

Laminectomy, cervical

Clinical Scenario

Used in surgical management of cervical radiculopathy.

Documentation Requirements

Surgical notes detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of cervical radiculopathy, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of cervical radiculopathy, improving the accuracy of diagnoses and treatment tracking. This specificity aids in 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 cervical radiculopathy and cervical spondylosis?

Cervical radiculopathy refers specifically to nerve root compression leading to symptoms in the arms, while cervical spondylosis is a degenerative condition of the cervical spine that may or may not cause radiculopathy.