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ICD-10 Guide
ICD-10 CodesM47.21

M47.21

Billable

Other spondylosis with radiculopathy, occipito-atlanto-axial region

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

Code Description

ICD-10 M47.21 is a billable code used to indicate a diagnosis of other spondylosis with radiculopathy, occipito-atlanto-axial region.

Key Diagnostic Point:

M47.21 refers to a specific type of spondylosis characterized by degenerative changes in the spine, particularly affecting the occipito-atlanto-axial region, which includes the base of the skull and the first two cervical vertebrae (C1 and C2). This condition can lead to radiculopathy, a condition where nerve roots are compressed or irritated, resulting in pain, weakness, or numbness that radiates along the path of the affected nerve. Spondylosis in this region may arise from age-related wear and tear, trauma, or inflammatory conditions such as ankylosing spondylitis. The presence of radiculopathy indicates that the degenerative changes are significant enough to affect nerve function, often necessitating a comprehensive treatment approach that may include physical therapy, medication, or surgical intervention. Accurate coding of M47.21 is crucial for proper reimbursement and reflects the complexity of managing patients with these conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various types of spondylosis and their associated symptoms.
  • Identifying the specific anatomical region affected (occipito-atlanto-axial).
  • Understanding the implications of radiculopathy and its clinical significance.
  • Navigating the overlap with other spinal conditions such as ankylosing spondylitis.

Audit Risk Factors

  • Inadequate documentation of radiculopathy symptoms.
  • Failure to specify the anatomical region affected.
  • Misclassification of spondylosis type.
  • Lack of imaging studies to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed imaging reports, surgical notes, and pre-operative assessments.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of the surgical approach and outcomes to support coding.

Neurology

Documentation Requirements

Comprehensive neurological evaluations and diagnostic imaging results.

Common Clinical Scenarios

Patients with chronic neck pain and radiculopathy undergoing conservative management.

Billing Considerations

Documenting the neurological deficits and response to treatment is critical for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M47.21 When
  • According to ICD
  • 10 coding guidelines, M47
  • 21 should be used when there is clear documentation of spondylosis with radiculopathy specifically in the occipito
  • atlanto
  • axial region
  • It is important to ensure that the diagnosis is supported by clinical findings and imaging studies

Exclusion Criteria

Do NOT use M47.21 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

63030CPT Code

Laminectomy, cervical, for decompression of spinal cord

Clinical Scenario

Used in cases where surgical intervention is required due to severe radiculopathy.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery clearly.

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 diagnoses and treatment plans. M47.21 provides a clear distinction for cases involving radiculopathy, which is essential for appropriate management and reimbursement.

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 diagnoses and treatment plans. M47.21 provides a clear distinction for cases involving radiculopathy, which is essential for appropriate management and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 M47.21 and M47.22?

M47.21 specifically refers to spondylosis with radiculopathy in the occipito-atlanto-axial region, while M47.22 refers to spondylosis with radiculopathy in the cervical region more broadly.