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ICD-10 Guide
ICD-10 CodesM51.26

M51.26

Billable

Other intervertebral disc displacement, lumbar region

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED08/28/2025

Code Description

ICD-10 M51.26 is a billable code used to indicate a diagnosis of other intervertebral disc displacement, lumbar region.

Key Diagnostic Point:

Other intervertebral disc displacement, lumbar region

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity
### Analysis of ICD-10 Code M51.26: Other Intervertebral Disc Displacement, Lumbar Region #### 1) Complexity Rating: Medium The complexity of coding M51.26 is rated as medium due to the need for precise documentation regarding the nature of the intervertebral disc displacement and its clinical implications. The code requires differentiation from other lumbar spine conditions, necessitating a thorough understanding of the patient's clinical presentation. #### 2) Documentation Requirements - **Clinical Diagnosis**: Clear documentation of the diagnosis of intervertebral disc displacement, specifying that it is in the lumbar region. - **Patient History**: Detailed history of symptoms, including onset, duration, and any prior treatments or interventions. - **Physical Examination Findings**: Neurological examination results, including any signs of nerve root involvement or radiculopathy. - **Imaging Studies**: Results from MRI, CT scans, or X-rays that confirm the diagnosis and describe the extent of displacement. - **Treatment Plan**: Documentation of the treatment approach, whether conservative management or surgical intervention, and the rationale for the chosen method. #### 3) Clinical Considerations - **Differential Diagnosis**: Consideration of other lumbar spine conditions such as herniated discs, degenerative disc disease, and spinal stenosis. - **Symptoms**: Common symptoms may include lower back pain, sciatica, and neurological deficits. The clinician should assess the impact of symptoms on daily activities. - **Management Options**: Treatment may range from conservative measures (physical therapy, medications) to surgical options (discectomy, fusion) depending on the severity and impact on the patient’s quality of life. #### 4) Audit Risk Factors - **Inadequate Documentation**: Lack of comprehensive documentation may lead to denials or audits, particularly if the clinical rationale for the diagnosis is unclear. - **Misuse of Codes**: Incorrectly coding M51.26 when a more specific code (e.g., for herniated disc) is warranted can trigger audits. - **Lack of Imaging Support**: Failure to provide imaging results that substantiate the diagnosis may increase audit risk. - **Inconsistent Clinical Notes**: Discrepancies between clinical notes and the diagnosis can raise flags during audits. #### 5) Coding Best Practices - **Use Specific Codes**: Always select the most specific code available that accurately reflects the patient's condition. - **Thorough Documentation**: Ensure that all relevant clinical information is documented in the medical record to support the diagnosis and coding. - **Regular Training**: Keep abreast of coding updates and guidelines to ensure compliance and accuracy in coding practices. - **Collaboration with Clinicians**: Work closely with healthcare providers to clarify any ambiguities in documentation and ensure that all necessary information is captured. - **Review Coding Guidelines**: Regularly consult the ICD-10-CM coding guidelines and updates from the Centers for Medicare & Medicaid Services (CMS) to ensure adherence to current standards. By adhering to these guidelines and best practices, healthcare professionals can ensure accurate coding for M51.26, thereby enhancing patient care and minimizing audit risks.

Specialty Focus

Medical Specialties

### Medical Specialties Related to ICD-10 Code M51.26: Other Intervertebral Disc Displacement, Lumbar Region #### 1) Primary Specialty - **Orthopedic Surgery (40%)** - Orthopedic surgeons frequently manage conditions related to intervertebral disc displacement, particularly in the lumbar region. They perform diagnostic evaluations, conservative management, and surgical interventions such as discectomy or spinal fusion. #### 2) Secondary Specialties - **Neurology (25%)** - Neurologists assess and treat neurological symptoms arising from lumbar disc displacement, including radiculopathy and myelopathy. - **Physical Medicine and Rehabilitation (PM&R) (20%)** - PM&R specialists focus on rehabilitation strategies, pain management, and functional recovery for patients with lumbar disc issues. - **Pain Management (10%)** - Pain management specialists provide interventions such as epidural steroid injections and other pain relief techniques for patients suffering from lumbar disc displacement. - **Chiropractic Care (5%)** - Chiropractors may offer conservative treatment options, including spinal manipulation and therapeutic exercises, to alleviate symptoms associated with lumbar disc displacement. #### 3) Documentation Requirements - **Clinical History:** - Detailed patient history including onset, duration, and nature of symptoms (e.g., pain, numbness, weakness). - **Physical Examination:** - Neurological examination findings, including reflexes, motor strength, and sensory deficits. - **Diagnostic Imaging:** - MRI or CT scan results confirming the diagnosis of intervertebral disc displacement. - **Treatment Plan:** - Documentation of conservative management strategies attempted (e.g., physical therapy, medications) and any surgical interventions performed. - **Follow-Up:** - Records of follow-up visits, response to treatment, and any changes in clinical status. #### 4) Clinical Scenarios - **Scenario 1:** - A 45-year-old male presents with lower back pain radiating to the left leg. MRI reveals a herniated lumbar disc at L4-L5. The orthopedic surgeon recommends a conservative treatment plan, including physical therapy and pain management. - **Scenario 2:** - A 60-year-old female with a history of chronic back pain experiences acute exacerbation with numbness in the right leg. Neurological evaluation shows L5 radiculopathy. The neurologist orders an MRI, confirming intervertebral disc displacement. - **Scenario 3:** - A 35-year-old male involved in a motor vehicle accident presents with severe lumbar pain. Imaging shows a displaced disc at L3-L4. The PM&R specialist develops a comprehensive rehabilitation program focusing on pain management and functional recovery. #### 5) Specialty Considerations - **Orthopedic Surgery:** - Surgeons must consider the patient's overall health, comorbidities, and the potential for conservative management before proceeding with surgical options. - **Neurology:** - Neurologists should be aware of the potential for neurological deficits and the need for timely intervention to prevent permanent damage. - **PM&R:** - Rehabilitation specialists should tailor treatment plans to the individual’s functional goals and pain levels, incorporating multidisciplinary approaches. - **Pain Management:** - Pain specialists must evaluate the appropriateness of interventional procedures based on the patient's response to conservative treatments and the severity of symptoms. - **Chiropractic Care:** - Chiropractors should collaborate with other specialists to ensure comprehensive care, particularly when symptoms suggest neurological involvement. ### Conclusion Understanding the implications of ICD-10 code M51.26 is crucial for healthcare professionals across various specialties. Proper documentation, awareness of clinical scenarios, and interdisciplinary collaboration are essential for effective management of patients with lumbar intervertebral disc displacement.

Coding Guidelines

Inclusion Criteria

Use M51.26 When
  • 10 Code: M51
  • Other Intervertebral Disc Displacement, Lumbar Region
  • 1) Inclusion Criteria
  • This code is used to classify conditions involving displacement of intervertebral discs in the lumbar region that are not specified as herniated or protruded
  • Conditions that may fall under this code include:
  • Disc bulges
  • Disc degeneration without herniation
  • Other unspecified types of disc displacement affecting the lumbar spine

Exclusion Criteria

Do NOT use M51.26 When
  • 2) Exclusion Notes

Related ICD-10 Codes

Related CPT Codes

### CPT Codes for ICD-10 M51.26 (Other Intervertebral Disc Displacement, Lumbar Region) #### 1. Lab/Diagnostic Procedures When diagnosing intervertebral disc displacement, the following CPT codes may be applicable: - **72148**: MRI, spinal canal and contents, lumbar; without contrast material - **72149**: MRI, spinal canal and contents, lumbar; with contrast material - **72150**: MRI, spinal canal and contents, lumbar; without and with contrast material - **72220**: CT, lumbar spine; without contrast material - **72221**: CT, lumbar spine; with contrast material - **72222**: CT, lumbar spine; without and with contrast material #### 2. Treatment Procedures Treatment for intervertebral disc displacement may include both conservative and surgical options. Relevant CPT codes include: - **63030**: Laminectomy, facetectomy, and foraminotomy, lumbar; single segment - **63042**: Laminectomy, facetectomy, and foraminotomy, lumbar; each additional segment - **62287**: Injection, anesthetic agent and/or steroid, into the epidural space, lumbar or sacral, single level - **20610**: Arthrocentesis, aspiration and/or injection into a major joint or bursa (if applicable for pain management) - **20936**: Implantation of intervertebral biomechanical device (if applicable) #### 3. Follow-Up Codes Follow-up visits may require evaluation and management (E/M) codes based on the complexity of the visit: - **99213**: Established patient office visit, low complexity - **99214**: Established patient office visit, moderate complexity - **99215**: Established patient office visit, high complexity - **99201-99205**: New patient office visit codes, depending on complexity #### 4. Reimbursement Ranges Reimbursement rates can vary significantly based on geographic location, payer contracts, and specific circumstances. However, general ranges for the listed procedures may be: - **MRI (72148)**: $500 - $1,500 - **CT (72220)**: $300 - $1,000 - **Laminectomy (63030)**: $5,000 - $15,000 - **Epidural Injection (62287)**: $300 - $1,200 - **E/M Codes (99213-99215)**: $75 - $250 #### 5. Billing Notes - Ensure that the diagnosis code (ICD-10 M51.26) is linked to the appropriate CPT codes for both diagnostic and treatment services. - Document all procedures and services thoroughly to support medical necessity. - Check payer-specific guidelines for any additional requirements or modifiers that may be necessary for reimbursement. - Consider using modifiers (e.g., -50 for bilateral procedures) where applicable to ensure accurate billing. - Be aware of the potential for bundled payments in surgical procedures, which may affect reimbursement. ### Conclusion Accurate coding and documentation are essential for proper reimbursement and compliance. Always refer to the latest coding guidelines and payer policies to ensure adherence to current standards.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

ICD-10 Impact for M51.26 (Other Intervertebral Disc Displacement, Lumbar Region)
The transition from ICD-9 to ICD-10 has significantly impacted the coding and classification of various medical conditions, including intervertebral disc displacement. Below is a detailed analysis of the implications of ICD-10 code M51.26.
1. Clinical Specificity vs ICD-9

ICD-9 vs ICD-10

ICD-10 Impact for M51.26 (Other Intervertebral Disc Displacement, Lumbar Region) The transition from ICD-9 to ICD-10 has significantly impacted the coding and classification of various medical conditions, including intervertebral disc displacement. Below is a detailed analysis of the implications of ICD-10 code M51.26. 1. Clinical Specificity vs ICD-9 ICD-10 offers enhanced clinical specificity compared to ICD-9. - ICD-9 Limitations: The ICD-9 coding system had limited codes for spinal conditions, often leading to vague classifications. For example, the ICD-9 code 722.10 (Displacement of intervertebral disc, lumbar region) did not differentiate between types of displacement or severity. - ICD-10 Advancements: M51.26 provides a more precise classification of "Other intervertebral disc displacement" specifically in the lumbar region. This specificity allows healthcare providers to document the exact nature of the condition, which can lead to better-targeted treatment plans and improved patient outcomes. 2. Quality Measures The transition to ICD-10 has implications for quality measures...

Reimbursement & Billing Impact

Reimbursement Impact

Resources

Clinical References

Here is a comprehensive list of resources for ICD-10 code M51.26 (Other intervertebral disc displacement, lumbar region): ### 1. Official Guidelines - **ICD-10-CM Official Guidelines for Coding and Reporting**: This document provides the official coding guidelines for the ICD-10-CM system, including conventions, general coding guidelines, and specific guidelines related to musculoskeletal disorders. - **Link**: [CDC ICD-10-CM Guidelines](https://www.cdc.gov/nchs/data/icd/10cmguidelines_2023.pdf) ### 2. Clinical References - **American Academy of Orthopaedic Surgeons (AAOS)**: Offers clinical practice guidelines and resources related to spine disorders, including intervertebral disc displacement. - **Link**: [AAOS Clinical Practice Guidelines](https://www.aaos.org/) - **UpToDate**: A clinical decision support resource that provides evidence-based information on the diagnosis and management of intervertebral disc disorders. - **Link**: [UpToDate](https://www.uptodate.com/) ### 3. Professional Organizations - **American Medical Association (AMA)**: Provides resources for coding, including updates on ICD-10 codes and guidelines. - **Link**: [AMA](https://www.ama-assn.org/) - **American Academy of Neurology (AAN)**: Offers resources and guidelines related to neurological conditions, including those affecting the lumbar spine. - **Link**: [AAN](https://www.aan.com/) ### 4. Educational Materials - **AAPC**: Offers courses and webinars on ICD-10 coding, including specific modules on musculoskeletal coding. - **Link**: [AAPC Education](https://www.aapc.com/training/) - **American Health Information Management Association (AHIMA)**: Provides educational resources, webinars, and certification programs focused on health information management and coding. - **Link**: [AHIMA](https://www.ahima.org/) ### 5. Online Tools - **CMS ICD-10 Lookup Tool**: A searchable database that allows healthcare professionals to look up ICD-10 codes and descriptions. - **Link**: [CMS ICD-10 Lookup](https://www.cms.gov/medicare/coding/ICD10) - **Find-A-Code**: An online coding tool that provides access to ICD-10 codes, including detailed descriptions and coding guidelines. - **Link**: [Find-A-Code](https://www.findacode.com/) - **ICD10Data.com**: A user-friendly online resource for searching ICD-10 codes, including M51.26, with additional information on coding guidelines and related codes. - **Link**: [ICD10Data.com](https://www.icd10data.com/) These resources will assist healthcare professionals in understanding and accurately coding for M51.26, ensuring compliance with official coding standards and improving patient care.

Coding & Billing References

Here is a comprehensive list of resources for ICD-10 code M51.26 (Other intervertebral disc displacement, lumbar region): ### 1. Official Guidelines - **ICD-10-CM Official Guidelines for Coding and Reporting**: This document provides the official coding guidelines for the ICD-10-CM system, including conventions, general coding guidelines, and specific guidelines related to musculoskeletal disorders. - **Link**: [CDC ICD-10-CM Guidelines](https://www.cdc.gov/nchs/data/icd/10cmguidelines_2023.pdf) ### 2. Clinical References - **American Academy of Orthopaedic Surgeons (AAOS)**: Offers clinical practice guidelines and resources related to spine disorders, including intervertebral disc displacement. - **Link**: [AAOS Clinical Practice Guidelines](https://www.aaos.org/) - **UpToDate**: A clinical decision support resource that provides evidence-based information on the diagnosis and management of intervertebral disc disorders. - **Link**: [UpToDate](https://www.uptodate.com/) ### 3. Professional Organizations - **American Medical Association (AMA)**: Provides resources for coding, including updates on ICD-10 codes and guidelines. - **Link**: [AMA](https://www.ama-assn.org/) - **American Academy of Neurology (AAN)**: Offers resources and guidelines related to neurological conditions, including those affecting the lumbar spine. - **Link**: [AAN](https://www.aan.com/) ### 4. Educational Materials - **AAPC**: Offers courses and webinars on ICD-10 coding, including specific modules on musculoskeletal coding. - **Link**: [AAPC Education](https://www.aapc.com/training/) - **American Health Information Management Association (AHIMA)**: Provides educational resources, webinars, and certification programs focused on health information management and coding. - **Link**: [AHIMA](https://www.ahima.org/) ### 5. Online Tools - **CMS ICD-10 Lookup Tool**: A searchable database that allows healthcare professionals to look up ICD-10 codes and descriptions. - **Link**: [CMS ICD-10 Lookup](https://www.cms.gov/medicare/coding/ICD10) - **Find-A-Code**: An online coding tool that provides access to ICD-10 codes, including detailed descriptions and coding guidelines. - **Link**: [Find-A-Code](https://www.findacode.com/) - **ICD10Data.com**: A user-friendly online resource for searching ICD-10 codes, including M51.26, with additional information on coding guidelines and related codes. - **Link**: [ICD10Data.com](https://www.icd10data.com/) These resources will assist healthcare professionals in understanding and accurately coding for M51.26, ensuring compliance with official coding standards and improving patient care.

Frequently Asked Questions