Degenerative spinal disease of the lumbar vertebrae (arthrosis, osteophyte formation, facet joint degeneration) producing documented nerve root compression or irritation — radiculopathy — localized to the lumbar region.
Verified May 8, 2026 · 6 sources ↓
- Status
- Billable
- Chapter
- 13
- Related CPT
- 15
- Region
- Spine
Documentation tips
What should appear in the chart to support M47.26.
Source · Editorial brief grounded in 6 cited references ↓
- Explicitly name the diagnosis as 'lumbar spondylosis with radiculopathy' — terms like 'lumbar DDD with leg pain' are insufficient without the word radiculopathy or a dermatomal description.
- Record the specific nerve root(s) implicated (e.g., L4, L5, S1) and the corresponding dermatomal distribution of symptoms to support medical necessity.
- Document imaging findings that correlate with radiculopathy: foraminal stenosis, osteophyte encroachment on nerve root canal, or disc-osteophyte complex on MRI or CT.
- Distinguish myelopathy from radiculopathy in the note — if long-tract signs (gait instability, hyperreflexia, Babinski) are absent, state that explicitly to support M47.26 over M47.16.
- If both the lumbar and lumbosacral segments are involved, specify the primary level to determine whether M47.26 (lumbar) or M47.27 (lumbosacral) is the correct code — do not use both for the same nerve root.
Related CPT procedures
Procedure codes commonly billed with M47.26. Linking the right diagnosis to the right procedure is what establishes medical necessity.
Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis
Common coding pitfalls
The recurring mistakes coders make with M47.26 and adjacent codes.
Source · Editorial brief grounded in CDC ICD-10-CM tabular guidance, AAOS coding references, and cited references ↓
- Coding M47.26 when the documented etiology of radiculopathy is a herniated disc rather than spondylosis — disc-mediated radiculopathy belongs under M51.16, not M47.26.
- Using M54.16 (radiculopathy, lumbar region) alongside M47.26 — the Tabular List excludes M54.16 when spondylosis with radiculopathy is already coded, making dual-coding an audit risk.
- Dropping to M47.20 (site unspecified) when the lumbar region is documented — always assign the most specific site code available.
- Assigning M47.26 based on imaging findings of spondylosis alone without a clinical diagnosis of radiculopathy — degeneration visible on MRI does not equal radiculopathy for coding purposes.
- Confusing lumbar (M47.26) with lumbosacral (M47.27) — if the pathology is at L5-S1 and the provider documents lumbosacral involvement, M47.27 is correct.
- Selecting M47.16 (myelopathy) when the note describes radiculopathy — these are mutually exclusive categories; the distinction must be driven by the clinical documentation, not coder inference.
Clinical context
Source · Editorial summary grounded in 6 cited references ↓
M47.26 applies when lumbar spondylosis — degenerative disc changes, osteophyte formation, or facet arthrosis — produces radiculopathy: dermatomal pain, numbness, tingling, or motor weakness radiating into the lower extremity. The radiculopathy must be explicitly documented by the treating provider; a diagnosis of nonspecific low back pain does not support this code.
Critical distinction: if the encounter involves myelopathy (cord compression with long-tract signs) rather than radiculopathy, use M47.16 (other spondylosis with myelopathy, lumbar region). If pathology extends to the lumbosacral junction, M47.27 (lumbosacral region) may be more precise. When radiculopathy is caused by intervertebral disc disease rather than spondylosis, M51.16 (intervertebral disc disorder with radiculopathy, lumbar region) is the correct parent — spondylosis and disc disorders are distinct etiologies under ICD-10-CM.
M47.26 is billable and specific; no additional 7th-character extension is required. It sits under parent M47.2 (other spondylosis with radiculopathy), which is not itself billable. When symptoms also include isolated lumbar radiculopathy without a confirmed structural etiology, M54.16 (radiculopathy, lumbar region) is excluded from use alongside M47.26 — the spondylosis code already captures the radicular component.
Sibling codes
Other billable codes under M47.2 (laterality / anatomic variants).
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between M47.26 and M54.16?
02When should I use M47.27 (lumbosacral) instead of M47.26 (lumbar)?
03Can M47.26 and M51.16 be coded together?
04Does M47.26 require a 7th-character extension?
05What imaging is needed to support M47.26?
06Is M47.26 appropriate for a patient with sciatica caused by lumbar spondylosis?
07What CPT procedures most commonly pair with M47.26?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CDC ICD-10-CM Tabular List 2026 (effective October 1, 2025)
- 02icd10data.comhttps://www.icd10data.com/ICD10CM/Codes/M00-M99/M45-M49/M47-/M47.26
- 03aapc.comhttps://www.aapc.com/codes/icd-10-codes/M47.26
- 04outsourcestrategies.comhttps://www.outsourcestrategies.com/blog/icd-10-codes-for-documenting-spondylosis-a-degenerative-condition/
- 05icdcodes.aihttps://icdcodes.ai/diagnosis/spondylosis-with-radiculopathy/
- 06cms.govhttps://www.cms.gov/medicare/coding/icd10/downloads/icd10clinicalconceptsorthopedics1.pdf
Mira AI Scribe
Mira captures the dermatomal distribution of symptoms (e.g., pain radiating from lumbar spine into posterior thigh or below the knee), the specific nerve root level, imaging findings confirming foraminal stenosis or osteophyte-nerve root contact, and the absence of myelopathic signs — preventing a downcode to M47.20 (unspecified site) or a mismatch with M47.16 (myelopathy) that triggers payer audit.
See how Mira captures M47.26 documentation