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ICD-10 Guide
ICD-10 CodesM46.56

M46.56

Billable

Other infective spondylopathies, lumbar region

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

Code Description

ICD-10 M46.56 is a billable code used to indicate a diagnosis of other infective spondylopathies, lumbar region.

Key Diagnostic Point:

Infective spondylopathies refer to inflammatory conditions of the spine caused by infectious agents, which can lead to significant morbidity if not diagnosed and treated promptly. The lumbar region is particularly susceptible due to its weight-bearing function and mobility. Conditions such as osteomyelitis, discitis, and spondylodiscitis can manifest in this area, often presenting with back pain, fever, and neurological deficits. Diagnosis typically involves imaging studies, such as MRI or CT scans, and laboratory tests to identify the causative organism. Treatment may include antibiotics, surgical intervention, or both, depending on the severity and extent of the infection. It is crucial for healthcare providers to differentiate between infective spondylopathies and other inflammatory conditions like ankylosing spondylitis or spinal stenosis, as the management strategies differ significantly. 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 infective and non-infective spondylopathies
  • Need for comprehensive documentation of clinical findings
  • Variability in presentation and symptoms among patients
  • Potential for overlapping diagnoses with other spinal conditions

Audit Risk Factors

  • Inadequate documentation of infectious etiology
  • Failure to include imaging and lab results in the medical record
  • Misclassification of the condition as non-infective
  • Lack of clarity in the treatment plan and follow-up

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of present illness, imaging results, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with back pain, fever, and neurological symptoms requiring surgical intervention.

Billing Considerations

Orthopedic surgeons must ensure that the infectious nature of the condition is clearly documented to support the use of M46.56.

Infectious Disease

Documentation Requirements

Comprehensive lab results, cultures, and response to antibiotic therapy should be documented.

Common Clinical Scenarios

Patients with suspected spinal infections requiring antibiotic management and monitoring.

Billing Considerations

Infectious disease specialists should document the specific pathogen identified to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use M46.56 When
  • According to ICD
  • 10 coding guidelines, M46
  • 56 should be used when the infective nature of the spondylopathy is confirmed through clinical and laboratory findings
  • It is important to ensure that the documentation supports the diagnosis and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use M46.56 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

CT scan of the lumbar spine

Clinical Scenario

Used to evaluate suspected infective spondylopathy.

Documentation Requirements

Indication for the scan must be documented, including symptoms and prior treatments.

Specialty Considerations

Orthopedic and infectious disease specialists should ensure imaging results are included in the patient's record.

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 data collection and reimbursement processes. M46.56 provides a distinct code for lumbar infections, which was less clearly defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of infective spondylopathies, improving the accuracy of data collection and reimbursement processes. M46.56 provides a distinct code for lumbar infections, which was less clearly defined in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. M46.56 provides a distinct code for lumbar infections, which was less clearly defined in ICD-9.

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 Staphylococcus aureus, tuberculosis, and fungal infections. Risk factors include immunocompromised states, recent surgeries, and intravenous drug use.