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v1.0.0
ICD-10 Guide
ICD-10 CodesM47.896

M47.896

Billable

Other spondylosis, lumbar region

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

Code Description

ICD-10 M47.896 is a billable code used to indicate a diagnosis of other spondylosis, lumbar region.

Key Diagnostic Point:

M47.896 refers to 'Other spondylosis' specifically in the lumbar region, which encompasses a variety of degenerative spinal conditions affecting the lumbar vertebrae. Spondylosis is characterized by the degeneration of the intervertebral discs and the formation of osteophytes (bone spurs) that can lead to spinal instability and pain. This condition may present with symptoms such as lower back pain, stiffness, and reduced mobility. It can also be associated with other conditions like spinal stenosis, where the spinal canal narrows, potentially compressing spinal nerves. Inflammatory spine conditions, such as ankylosing spondylitis, may also be considered under this umbrella, although they have distinct diagnostic criteria. Accurate diagnosis often requires imaging studies, such as X-rays or MRIs, to assess the degree of degeneration and rule out other pathologies. Treatment typically involves physical therapy, pain management, and in some cases, surgical intervention. Understanding the nuances of spondylosis and its related conditions is crucial for proper coding and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions that fall under spondylosis
  • Differentiation from other spinal disorders
  • Need for precise documentation of symptoms and imaging results
  • Potential overlap with inflammatory conditions like ankylosing spondylitis

Audit Risk Factors

  • Inadequate documentation of symptoms and imaging findings
  • Misclassification of spondylosis types
  • Failure to document co-existing conditions
  • Inconsistent use of terminology in clinical notes

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes including physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic lower back pain, radiculopathy, or post-surgical follow-ups.

Billing Considerations

Ensure clarity in differentiating between degenerative and inflammatory conditions.

Rheumatology

Documentation Requirements

Comprehensive assessment of inflammatory markers, patient history, and response to treatment.

Common Clinical Scenarios

Patients with suspected ankylosing spondylitis or other inflammatory spine diseases.

Billing Considerations

Documenting the presence of systemic symptoms or family history of autoimmune diseases.

Coding Guidelines

Inclusion Criteria

Use M47.896 When
  • According to ICD
  • 10 guidelines, M47
  • 896 should be used when the spondylosis is specifically identified as 'other' and not classified under more specific codes
  • Documentation must support the diagnosis, including imaging and clinical findings

Exclusion Criteria

Do NOT use M47.896 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

72148CPT Code

MRI of the lumbar spine

Clinical Scenario

When imaging is required to assess the extent of spondylosis.

Documentation Requirements

Document the clinical rationale for imaging and findings.

Specialty Considerations

Orthopedic and neurology specialties often utilize this code.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spondylosis, improving the accuracy of diagnoses and treatment plans. M47.896 provides a clear classification for cases that do not fit into more defined categories, enhancing data collection and analysis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylosis, improving the accuracy of diagnoses and treatment plans. M47.896 provides a clear classification for cases that do not fit into more defined categories, enhancing data collection and analysis.

Reimbursement & Billing Impact

reimbursement and compliance.

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 is the difference between M47.896 and M47.9?

M47.896 is used for specific cases of lumbar spondylosis that do not fit into more defined categories, while M47.9 is a general code for unspecified spondylosis.