Wiki Billing two M54.1- codes together

[VMaes]

I have a few denials with both M54.15 and M54.16 on the same claim. I am seeing these could possibly be exclusionary and I am hoping to verify this and find out why?

 

[kdlberg]

M54.16 is redundant. You've already told them the patient has pain somewhere in the lumbar region because M54.15 says the problem is in the thoracic and lumbar areas. That could be anything from T1 to L1 or T12 to L5. As long as you have one T and one L, or the provider says it's in the thoracolumbar region, you only need the one code.