M54.12 — Radiculopathy, cervical region

Clinical Definition

Cervical radiculopathy is a clinical condition caused by compression, inflammation, or injury to a cervical nerve root (C2-C8) as it exits the spinal canal through the neural foramen. The most commonly affected levels are C6 and C7, resulting from degenerative disc disease, cervical spondylosis, disc herniation, or foraminal stenosis. Patients typically present with radiating pain from the neck into the shoulder, arm, and hand following a dermatomal distribution, along with numbness, tingling, and potential motor weakness in the muscles innervated by the affected nerve root.

ICD-10-CM code M54.12 specifically identifies radiculopathy localized to the cervical region. This code captures the clinical syndrome of cervical nerve root compression regardless of the underlying structural cause. It is distinct from cervical disc codes (M50.1x) that identify the disc disorder itself as the primary condition. When the provider documents cervical radiculopathy without attributing it to a specific disc herniation or structural lesion, M54.12 is the appropriate code. When a cervical disc disorder with radiculopathy is documented, the M50.1x codes should be used instead, as they capture both the structural cause and the radiculopathy.

Diagnosis is established through clinical examination demonstrating dermatomal sensory changes, myotomal weakness, and diminished reflexes. Provocative tests such as the Spurling's maneuver (axial compression with lateral flexion reproducing radicular symptoms) support the clinical diagnosis. MRI of the cervical spine is the gold-standard imaging study to identify the structural cause. Electrodiagnostic studies (EMG/NCS) may be used to confirm nerve root involvement and exclude peripheral neuropathy. Treatment ranges from conservative management (physical therapy, NSAIDs, epidural steroid injections) to surgical decompression in refractory cases.

When to Use M54.12

• ✓The provider documents cervical radiculopathy or a pinched nerve in the neck without attributing it to a specific cervical disc disorder.
• ✓The patient presents with radicular arm pain following a cervical dermatomal pattern, and the documentation identifies the condition as cervical radiculopathy.
• ✓MRI or clinical examination demonstrates cervical nerve root compression, and the provider documents the diagnosis as radiculopathy rather than as a specific disc disorder.
• ✓The patient is being evaluated or treated for cervical radiculopathy symptoms (radiating arm pain, numbness, weakness) and the provider uses the term 'cervical radiculopathy' in the assessment.
• ✓Coding from a problem list or encounter summary where the clinician documents cervical radiculopathy as the diagnosis without specifying the underlying structural pathology.

Common Coding Mistakes

Related & Differential Codes

Documentation Requirements

• 1Spinal region: clearly document that the radiculopathy involves the cervical spine — specify 'cervical radiculopathy' to support M54.12 assignment.
• 2Affected nerve root level when identifiable: document the specific cervical level (e.g., C5-C6, C6-C7) based on clinical findings or imaging.
• 3Laterality: specify whether the radiculopathy is right-sided, left-sided, or bilateral, even though the ICD-10 code does not distinguish laterality.
• 4Symptoms and dermatomal distribution: document radiating pain pattern, sensory changes (numbness, tingling), motor weakness, and reflex changes with the corresponding nerve root distribution.
• 5Provocative test results: document findings from Spurling's test, shoulder abduction relief sign, and other relevant clinical maneuvers.
• 6Imaging findings: document MRI results showing disc herniation, foraminal stenosis, osteophyte formation, or other structural causes of nerve root compression.
• 7Underlying structural cause if known: specify whether the radiculopathy is due to disc herniation (M50.1x), spondylosis (M47.22), or other pathology to allow assignment of the most specific code.
• 8Treatment plan: document conservative management (physical therapy, medications, injections) or surgical referral decisions.

Reimbursement & Billing Notes

ICD-10-CM code M54.12 is a valid, billable code accepted by Medicare, Medicaid, and commercial payers for encounters related to cervical radiculopathy. It is commonly used to support medical necessity for cervical spine MRI, electrodiagnostic studies, physical therapy referrals, and cervical epidural steroid injections. Payers may require documentation of failed conservative treatment before authorizing advanced imaging or interventional procedures.

For prior authorization of cervical epidural steroid injections or surgical decompression, payers typically require documentation of the duration of symptoms, failed conservative measures (usually 4-6 weeks), and imaging correlation with clinical findings. M54.12 does not map to a CMS-HCC risk adjustment category in the standard V28 model, but accurate coding supports appropriate resource utilization and quality measure reporting. When the underlying cause is a cervical disc disorder, using the more specific M50.1x code instead of M54.12 provides better clinical specificity for payer review.

Frequently Asked Questions