ICD-10 Coding for Osteoarthritis of the Back(M47.816, M47.817)
Complete ICD-10-CM coding and documentation guide for Osteoarthritis of the Back. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Osteoarthritis of the Back
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M47.816 | Spondylosis without myelopathy or radiculopathy, lumbar region | Use for primary osteoarthritis of the lumbar facet joints confirmed by imaging. |
|
| M47.817 | Spondylosis without myelopathy or radiculopathy, lumbosacral region | Use for primary osteoarthritis of the lumbosacral facet joints confirmed by MRI. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for osteoarthritis of the back
Essential facts and insights about Osteoarthritis of the Back
Primary ICD-10-CM Codes for osteoarthritis back
Decision Criteria
clinical Criteria
- Imaging shows degenerative changes in lumbar facet joints.
documentation Criteria
- Document specific site and type of osteoarthritis.
Applicable To
- Lumbar facet joint osteoarthritis
Excludes
- Spondylosis with myelopathy (M47.89)
Clinical Validation Requirements
- Imaging showing joint space narrowing and osteophytes
- Physical exam indicating limited lumbar extension
Code-Specific Risks
- Confusion with M19.90, which is for peripheral osteoarthritis.
Coding Notes
- Ensure imaging confirmation to avoid audit risks.
M47.817 - Spondylosis without myelopathy or radiculopathy, lumbosacral region
Use for primary osteoarthritis of the lumbosacral facet joints confirmed by MRI.
Applicable To
- Lumbosacral facet joint osteoarthritis
Excludes
- Spondylosis with myelopathy (M47.89)
Clinical Validation Requirements
- MRI showing synovial cyst compression
- Localized pain to L5-S1 facet joints
Coding Notes
Ensure MRI confirmation to avoid audit risks.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain due to trauma
G89.21Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Low back pain
M54.5Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Osteoarthritis of the Back to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M47.816.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Increased risk of audits., Financial: Potential for claim denials.
Mitigation Strategy
Always confirm diagnosis with imaging., Specify osteoarthritis in documentation.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data on osteoarthritis prevalence.
Mitigation Strategy
Use M47.8- series for spinal osteoarthritis.
Impact
Using unspecified codes like M54.5 can trigger audits.
Mitigation Strategy
Ensure specific diagnosis and documentation.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Osteoarthritis of the Back, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Osteoarthritis of the Back
Use these documentation templates to ensure complete and accurate documentation for Osteoarthritis of the Back. These templates include all required elements for proper coding and billing.
Chronic low back pain due to lumbar osteoarthritis
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Osteoarthritis of the Back? Ask your questions below.