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v1.0.0
ICD-10 Guide
DiagnosesLumbar Facet Arthropathy

Lumbar Facet Arthropathy

ICD-10 Coding for Lumbar Facet Arthropathy(M46.96, M47.816)

PRIMARY SPECIALTYPain Management
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Lumbar Facet Arthropathy?
Essential facts and insights about Lumbar Facet Arthropathy

Key Clinical Considerations:

  • Chronic lower back pain localized to the lumbar region
  • Pain exacerbated by extension or rotation of the spine
  • Radiating pain to the buttocks or thighs

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including onset, duration, and nature of pain
  • Results from imaging studies (e.g., MRI, CT) showing facet joint degeneration
  • Physical exam findings such as tenderness over the lumbar facet joints

Coding Guidelines

Usage Guidelines & Examples

  • Use M47.817 for facet arthropathy specifically; M54.5 is broader for low back pain.
  • Common errors include using non-specific codes or omitting imaging results.

Code Exclusions

Important Exclusions

  • Fractures or tumors affecting the lumbar spine
  • Other forms of arthritis or inflammatory conditions

Related ICD-10 Codes

Primary Codes
M47.817
Other spondylosis, lumbar region
M54.5
Low back pain
Ancillary Codes
M54.5
Differential Codes
M47.816
M46.96

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Pain Management

Specialty Applications

  • Adults with chronic back pain, particularly those over 40 years old
  • Pain management clinics, orthopedic practices, and rehabilitation centers

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

Documentation requirements?

Include detailed patient history, physical exam findings, and imaging results.

Billing considerations?

Ensure accurate coding to reflect the severity and complexity of the condition.