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ICD-10 Guide
ICD-10 CodesM46.55

M46.55

Billable

Other infective spondylopathies, thoracolumbar region

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

Code Description

ICD-10 M46.55 is a billable code used to indicate a diagnosis of other infective spondylopathies, thoracolumbar region.

Key Diagnostic Point:

M46.55 refers to other infective spondylopathies affecting the thoracolumbar region of the spine. This condition encompasses a variety of infectious processes that can lead to inflammation and degeneration of the vertebrae and surrounding structures. Common causes include bacterial infections such as osteomyelitis, tuberculosis, and brucellosis, which can result in significant pain, mobility issues, and neurological deficits if not treated promptly. Patients may present with symptoms such as localized back pain, fever, and neurological signs depending on the extent of the infection and any resultant complications like abscess formation or spinal instability. Diagnosis typically involves imaging studies such as MRI or CT scans, along with laboratory tests to identify the causative organism. Treatment often requires a multidisciplinary approach, including antibiotics, pain management, and possibly surgical intervention to address structural instability or decompress neural elements. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of infectious agents that can cause spondylopathy.
  • Differential diagnosis with other spine conditions.
  • Need for detailed clinical documentation to support the diagnosis.
  • Potential for overlapping symptoms with non-infective spondylopathies.

Audit Risk Factors

  • Inadequate documentation of the infectious agent.
  • Failure to document the clinical rationale for the diagnosis.
  • Lack of imaging or lab results to support the diagnosis.
  • Misclassification of the condition as non-infective.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed history of infection, lab results, and treatment plans.

Common Clinical Scenarios

Patients presenting with fever and back pain, suspected osteomyelitis.

Billing Considerations

Need for clear documentation of the infectious agent and response to treatment.

Orthopedic Surgery

Documentation Requirements

Surgical notes, imaging studies, and post-operative care documentation.

Common Clinical Scenarios

Surgical intervention for abscess drainage or spinal stabilization.

Billing Considerations

Documentation of the surgical indication and outcomes is crucial for coding.

Coding Guidelines

Inclusion Criteria

Use M46.55 When
  • According to the official coding guidelines, M46
  • 55 should be used when the spondylopathy is specifically due to an infectious process
  • Coders must ensure that the documentation supports the diagnosis and that any relevant lab or imaging results are included

Exclusion Criteria

Do NOT use M46.55 When
  • Exclusion criteria include conditions that are not infectious in nature

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, spine, thoracic, including flexion and extension views.

Clinical Scenario

Used when imaging is required to assess the extent of infection.

Documentation Requirements

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

Specialty Considerations

Orthopedic and Infectious Disease specialists 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 infective spondylopathies, improving the accuracy of patient records and reimbursement processes. M46.55 provides a clear distinction from non-infective conditions, which aids in clinical management and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of infective spondylopathies, improving the accuracy of patient records and reimbursement processes. M46.55 provides a clear distinction from non-infective conditions, which aids in clinical management and research.

Reimbursement & Billing Impact

reimbursement processes. M46.55 provides a clear distinction from non-infective conditions, which aids in clinical management and research.

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 common causes of infective spondylopathies?

Common causes include bacterial infections such as osteomyelitis, tuberculosis, and brucellosis, which can lead to inflammation and degeneration of the vertebrae.