M54.16: Radiculopathy, lumbar region
Billable ICD-10-CM code, FY2027
What ICD-10-CM says
Notes at M54.1, Radiculopathy (they apply to every code under it)
Includes
- Brachial neuritis or radiculitis NOS
- Lumbar neuritis or radiculitis NOS
- Lumbosacral neuritis or radiculitis NOS
- Thoracic neuritis or radiculitis NOS
- Radiculitis NOS
Excludes1 (never coded with M54.16)
- neuralgia and neuritis NOS (M79.2)
- radiculopathy with cervical disc disorder (M50.1)
- radiculopathy with lumbar and other intervertebral disc disorder (M51.1-)
- radiculopathy with spondylosis (M47.2-)
What M54.16 covers
M54.16 is for lumbar radiculopathy: irritation of a nerve root in the lumbar spine, often felt as pain, numbness or tingling in the leg. The M54.1 subcategory also covers lumbar neuritis or radiculitis NOS.
Spine, pain, physical therapy and primary care practices use it. Region matters: M54.17 is lumbosacral radiculopathy and M54.15 thoracolumbar. Sciatica on its own has a separate subcategory, M54.3-, and lumbago with sciatica is M54.4-.
Billing and coding notes
The M54.1 subcategory has an excludes1 list that changes the code when the cause is known. Radiculopathy with a lumbar disc disorder is coded in M51.1-, and radiculopathy with spondylosis in M47.2-. If the provider links the radiculopathy to a herniated disc or to spondylosis, M54.16 is not reported.
Choose the region from the documentation. If the notes say L5-S1 or lumbosacral, M54.17 is more accurate than M54.16. Neuralgia and neuritis NOS (M79.2) is also an excludes1.
Related codes under M54.1
- M54.10 Radiculopathy, site unspecified
- M54.11 Radiculopathy, occipito-atlanto-axial region
- M54.12 Radiculopathy, cervical region
- M54.13 Radiculopathy, cervicothoracic region
- M54.14 Radiculopathy, thoracic region
- M54.15 Radiculopathy, thoracolumbar region
- M54.17 Radiculopathy, lumbosacral region
- M54.18 Radiculopathy, sacral and sacrococcygeal region
Questions about M54.16
Can M54.16 be coded with a disc herniation code?
Not when the radiculopathy comes from the disc. Radiculopathy with a lumbar disc disorder (M51.1-) is an excludes1 at M54.1, so the M51.1- code is used on its own.
What is the difference between M54.16 and M54.17?
Only the region. M54.16 is the lumbar region and M54.17 is the lumbosacral region. Pick the one that matches the levels the provider documents.
ICD-10-CM in CloudMedico
In CloudMedico, a visit's diagnoses come from the current ICD-10-CM list. For US practices, the visit flags a code that isn't billable on its date, and a superbill made from an invoice carries the visit's diagnoses.
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