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ICD-10 Guide
ICD-10 CodesM47.28

M47.28

Billable

Other spondylosis with radiculopathy, sacral and sacrococcygeal region

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

Code Description

ICD-10 M47.28 is a billable code used to indicate a diagnosis of other spondylosis with radiculopathy, sacral and sacrococcygeal region.

Key Diagnostic Point:

M47.28 refers to a specific type of spondylosis characterized by degenerative changes in the spine, particularly affecting the sacral and sacrococcygeal regions. This condition often leads to radiculopathy, which is the compression or irritation of spinal nerves resulting in pain, numbness, or weakness that radiates along the nerve pathway. Spondylosis can arise from various factors, including age-related degeneration, trauma, or inflammatory conditions such as ankylosing spondylitis. In cases where spinal stenosis is present, the spinal canal narrows, further exacerbating nerve compression. Patients may experience significant discomfort and functional limitations, necessitating a comprehensive evaluation and management plan. Treatment options may include physical therapy, pain management, and in some cases, surgical intervention. Accurate coding is essential for appropriate reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of spondylosis and associated radiculopathy
  • Understanding the anatomical specificity of the sacral and sacrococcygeal regions
  • Identifying the presence of additional conditions such as spinal stenosis
  • Documenting the severity and impact of radiculopathy on patient function

Audit Risk Factors

  • Inadequate documentation of radiculopathy symptoms
  • Failure to specify the exact location of spondylosis
  • Misclassification of the type of spondylosis
  • Lack of evidence for conservative treatment prior to surgical intervention

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, clinical notes on physical examination, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic lower back pain and neurological symptoms.

Billing Considerations

Ensure clear documentation of the relationship between spondylosis and radiculopathy.

Neurology

Documentation Requirements

Neurological assessments, imaging studies, and treatment response documentation.

Common Clinical Scenarios

Patients with radicular pain and neurological deficits due to nerve root compression.

Billing Considerations

Document the neurological examination findings thoroughly to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use M47.28 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include details about the patient's symptoms, the duration of the condition, and any treatments attempted

Exclusion Criteria

Do NOT use M47.28 When
  • Exclude codes for conditions that do not meet the criteria for M47

Related ICD-10 Codes

Related CPT Codes

63030CPT Code

Laminectomy, lumbar

Clinical Scenario

Used in cases of severe radiculopathy due to spinal stenosis.

Documentation Requirements

Pre-operative assessments, imaging studies, and surgical notes.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spondylosis and related conditions, improving the accuracy of patient records and reimbursement processes. M47.28 provides a clear distinction for cases involving radiculopathy in the sacral region.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylosis and related conditions, improving the accuracy of patient records and reimbursement processes. M47.28 provides a clear distinction for cases involving radiculopathy in the sacral region.

Reimbursement & Billing Impact

reimbursement processes. M47.28 provides a clear distinction for cases involving radiculopathy in the sacral region.

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

What are the key symptoms of spondylosis with radiculopathy?

Key symptoms include localized back pain, radiating pain into the legs, numbness, tingling, and muscle weakness, particularly in the lower extremities.