M51.16 ICD-10-CM Code: Intervertebral disc disorders with radiculopathy, lumbar region
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Other dorsopathies (M50-M54)
M51.16
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceIntervertebral disc disorders with radiculopathy, lumbar region
A condition where a disc in the lower back (lumbar spine) is damaged or displaced, irritating a nerve root and causing pain, numbness, or weakness radiating down the leg.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
Official- Sciatica due to intervertebral disc disorder
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M51.16 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M51.16 in this effective period.
Excludes 1
Official- lumbar radiculitis NOS (M54.16)
- sciatica NOS (M54.3)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M51.16 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M51.16 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M51.16 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is M51.16 an HCC code?
No. M51.16 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M51.16 is the ICD-10-CM diagnosis code for intervertebral disc disorders with radiculopathy, lumbar region. A condition where a disc in the lower back (lumbar spine) is damaged or displaced, irritating a nerve root and causing pain, numbness, or weakness radiating down the leg. M51.16 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other dorsopathies (m50-m54).
M51.16 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This is one of the most common disc-related codes; document which nerve root is affected (L3, L4, L5, or S1) for specificity.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M51.16 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is one of the most common disc-related codes; document which nerve root is affected (L3, L4, L5, or S1) for specificity
- •Sciatica is often associated with L5 or S1 radiculopathy; use this code when disc displacement is confirmed as the cause