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v1.0.0
ICD-10 Guide
ICD-10 CodesM46.80

M46.80

Billable

Other specified inflammatory spondylopathies, site unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M46.80 is a billable code used to indicate a diagnosis of other specified inflammatory spondylopathies, site unspecified.

Key Diagnostic Point:

M46.80 refers to a category of inflammatory spondylopathies that do not fall under more specific classifications. Inflammatory spondylopathies are a group of disorders characterized by inflammation of the spine and the surrounding structures. These conditions can lead to chronic pain, stiffness, and potential disability. Ankylosing spondylitis (AS) is the most well-known type, primarily affecting the sacroiliac joints and leading to fusion of the vertebrae over time. Other inflammatory spine conditions may include psoriatic arthritis and reactive arthritis, which can also affect the spine. Spinal stenosis, while not primarily an inflammatory condition, can coexist with inflammatory spondylopathies and contribute to symptoms. Accurate diagnosis often requires imaging studies and clinical evaluation to differentiate between various types of spondylopathies and to rule out other conditions. The unspecified site designation indicates that the specific location of the inflammation is not documented, which can complicate treatment and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of inflammatory spondylopathies
  • Need for comprehensive documentation to support unspecified site
  • Differentiation from other similar conditions like ankylosing spondylitis
  • Potential overlap with non-inflammatory spinal conditions

Audit Risk Factors

  • Insufficient documentation of symptoms and clinical findings
  • Failure to specify the site of inflammation
  • Inconsistent coding with clinical notes
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed patient history, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic back pain, stiffness, and inflammatory markers.

Billing Considerations

Rheumatologists must ensure that all inflammatory markers and imaging studies are documented to support the diagnosis.

Orthopedics

Documentation Requirements

Surgical notes, imaging studies, and pre-operative assessments.

Common Clinical Scenarios

Patients with spinal stenosis and concurrent inflammatory conditions requiring surgical intervention.

Billing Considerations

Orthopedic surgeons should document the relationship between inflammatory conditions and any surgical procedures performed.

Coding Guidelines

Inclusion Criteria

Use M46.80 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • 80 should be used when the specific site of inflammation is not documented
  • Ensure to review the patient's history and any imaging results

Exclusion Criteria

Do NOT use M46.80 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

72100CPT Code

Radiologic examination, spine, complete, including cervical, thoracic, and lumbar views

Clinical Scenario

Used when imaging is performed to evaluate inflammatory spondylopathies.

Documentation Requirements

Radiology report must be included in the patient's medical record.

Specialty Considerations

Rheumatologists and orthopedic surgeons should ensure imaging correlates with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of inflammatory spondylopathies, but M46.80 remains a catch-all for unspecified cases, which can lead to challenges in treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of inflammatory spondylopathies, but M46.80 remains a catch-all for unspecified cases, which can lead to challenges in treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

When should I use M46.80?

Use M46.80 when a patient presents with inflammatory spondylopathy symptoms, but the specific site of inflammation is not documented in the medical record.