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v1.0.0
ICD-10 Guide
ICD-10 CodesM47.816

M47.816

Billable

Spondylosis without myelopathy or radiculopathy, lumbar region

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

Code Description

ICD-10 M47.816 is a billable code used to indicate a diagnosis of spondylosis without myelopathy or radiculopathy, lumbar region.

Key Diagnostic Point:

Spondylosis refers to degenerative changes in the spine, particularly in the intervertebral discs and vertebrae, often due to aging or wear and tear. M47.816 specifically denotes lumbar spondylosis that does not involve myelopathy (spinal cord dysfunction) or radiculopathy (nerve root dysfunction). Patients may present with chronic lower back pain, stiffness, and reduced mobility. The condition is characterized by the presence of osteophytes (bone spurs), disc degeneration, and facet joint changes. While spondylosis is common in older adults, it can also occur in younger individuals due to genetic predisposition or previous spinal injuries. Diagnosis typically involves clinical evaluation, imaging studies such as X-rays or MRI, and exclusion of other conditions like ankylosing spondylitis or spinal stenosis. Treatment options may include physical therapy, pain management, and lifestyle modifications, with surgical intervention considered in severe cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spondylosis and other spinal conditions.
  • Understanding the absence of myelopathy or radiculopathy.
  • Accurate documentation of symptoms and imaging findings.
  • Potential overlap with other ICD-10 codes for spinal disorders.

Audit Risk Factors

  • Inadequate documentation of symptoms.
  • Failure to specify the absence of myelopathy or radiculopathy.
  • Misclassification of spondylosis as another spinal condition.
  • Lack of imaging studies to support diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic lower back pain and imaging showing degenerative changes.

Billing Considerations

Ensure clear documentation of neurological status to avoid misclassification.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, treatment goals, and progress notes.

Common Clinical Scenarios

Patients undergoing rehabilitation for chronic back pain due to spondylosis.

Billing Considerations

Document functional limitations and response to therapy.

Coding Guidelines

Inclusion Criteria

Use M47.816 When
  • Follow official ICD
  • CM guidelines for coding spondylosis, ensuring accurate documentation of the absence of myelopathy or radiculopathy
  • Include relevant imaging findings and clinical assessments

Exclusion Criteria

Do NOT use M47.816 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

72040CPT Code

X-ray of the lumbar spine, 2 or 3 views

Clinical Scenario

Used to confirm diagnosis of spondylosis.

Documentation Requirements

Include imaging results and clinical rationale for the study.

Specialty Considerations

Orthopedic specialists often order these studies.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding spondylosis, improving the accuracy of diagnoses and treatment plans. M47.816 provides a clear distinction from other spinal conditions, facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding spondylosis, improving the accuracy of diagnoses and treatment plans. M47.816 provides a clear distinction from other spinal conditions, facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specificity in coding spondylosis, improving the accuracy of diagnoses and treatment plans. M47.816 provides a clear distinction from other spinal conditions, facilitating better patient management.

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 spondylosis and ankylosing spondylitis?

Spondylosis is a degenerative condition primarily due to aging, while ankylosing spondylitis is an inflammatory disease that can lead to fusion of the spine. Spondylosis does not involve inflammatory changes or myelopathy.