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v1.0.0
ICD-10 Guide
ICD-10 CodesM46.87

M46.87

Billable

Other specified inflammatory spondylopathies, lumbosacral region

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

Code Description

ICD-10 M46.87 is a billable code used to indicate a diagnosis of other specified inflammatory spondylopathies, lumbosacral region.

Key Diagnostic Point:

M46.87 refers to inflammatory spondylopathies that do not fall under more specific categories, particularly affecting the lumbosacral region. This condition encompasses a variety of inflammatory diseases that primarily affect the spine, leading to pain, stiffness, and potential structural changes. Commonly associated with conditions like ankylosing spondylitis, these inflammatory spondylopathies can result in significant morbidity due to chronic pain and functional impairment. The lumbosacral region is particularly vulnerable due to its role in weight-bearing and mobility. Patients may present with symptoms such as lower back pain, reduced range of motion, and sometimes neurological symptoms if there is associated spinal stenosis. Diagnosis typically involves clinical evaluation, imaging studies, and laboratory tests to rule out other conditions. Treatment often includes anti-inflammatory medications, physical therapy, and in some cases, surgical intervention for severe cases. Accurate coding is essential for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of inflammatory conditions that can be classified under this code
  • Need for precise documentation to differentiate from other spondylopathies
  • Potential overlap with other codes related to ankylosing spondylitis and spinal stenosis
  • Variability in clinical presentation among patients

Audit Risk Factors

  • Inadequate documentation of the specific inflammatory condition
  • Failure to include relevant imaging studies in the medical record
  • Misuse of related codes leading to upcoding or downcoding
  • Lack of clear differentiation from non-inflammatory spondylopathies

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed patient history, physical examination findings, imaging results, and laboratory tests.

Common Clinical Scenarios

Patients presenting with chronic lower back pain, stiffness, and a family history of inflammatory spine diseases.

Billing Considerations

Ensure that all inflammatory markers and imaging studies are documented to support the diagnosis.

Orthopedics

Documentation Requirements

Surgical notes, pre-operative assessments, and post-operative follow-ups.

Common Clinical Scenarios

Patients requiring surgical intervention for severe spinal stenosis or deformity due to inflammatory spondylopathy.

Billing Considerations

Document the extent of spinal involvement and any neurological deficits to justify surgical procedures.

Coding Guidelines

Inclusion Criteria

Use M46.87 When
  • According to ICD
  • 10 guidelines, M46
  • 87 should be used when the specific inflammatory spondylopathy is not classified elsewhere
  • Coders must ensure that the documentation supports the diagnosis and that other more specific codes are not applicable

Exclusion Criteria

Do NOT use M46.87 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

72148CPT Code

MRI of the lumbar spine without contrast

Clinical Scenario

Used to evaluate inflammatory changes in the lumbosacral region.

Documentation Requirements

Indication for MRI must be clearly documented, including symptoms and prior treatments.

Specialty Considerations

Rheumatologists may order this to assess disease progression.

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, improving the accuracy of diagnoses and treatment plans. M46.87 provides a means to capture less common inflammatory conditions that may not fit into more defined categories.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of inflammatory spondylopathies, improving the accuracy of diagnoses and treatment plans. M46.87 provides a means to capture less common inflammatory conditions that may not fit into more defined categories.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of inflammatory spondylopathies, improving the accuracy of diagnoses and treatment plans. M46.87 provides a means to capture less common inflammatory conditions that may not fit into more defined categories.

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 M46.87 and M45?

M46.87 is used for other specified inflammatory spondylopathies affecting the lumbosacral region, while M45 specifically refers to ankylosing spondylitis. Accurate coding depends on the specific diagnosis documented.