ICD-10 Coding for Right SI Joint Pain(M46.11, S33.6XXA)
Complete ICD-10-CM coding and documentation guide for Right SI Joint Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right SI Joint Pain
M46-M53Primary Range
Other inflammatory spondylopathies and dorsopathies
This range includes codes for inflammatory conditions affecting the spine and sacroiliac joints, relevant for sacroiliitis.
Dislocation and sprain of joints and ligaments of lumbar spine and pelvis
This range includes codes for traumatic injuries to the sacroiliac joint, such as sprains.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M46.11 | Sacroiliitis, right | Use when inflammation of the right sacroiliac joint is confirmed by imaging and laboratory tests. |
|
| S33.6XXA | Sprain of sacroiliac joint, initial encounter | Use for acute traumatic injury to the sacroiliac joint. |
|
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 right SI joint pain
Essential facts and insights about Right SI Joint Pain
Primary ICD-10-CM Codes for right si joint pain
Decision Criteria
clinical Criteria
- Presence of imaging-confirmed inflammation and positive laboratory markers.
coding Criteria
- Avoid using M54.5 when specific sacroiliitis is diagnosed.
Applicable To
- Right sacroiliac joint inflammation
Excludes
- Mechanical sacroiliac joint disorders (M53.3)
Clinical Validation Requirements
- Imaging evidence of inflammation
- Elevated CRP/ESR levels
- Positive HLA-B27 test
Code-Specific Risks
- Incorrectly coding as low back pain (M54.5) without specifying sacroiliitis.
Coding Notes
- Ensure laterality is specified and confirm inflammatory markers are present.
S33.6XXA - Sprain of sacroiliac joint, initial encounter
Use for acute traumatic injury to the sacroiliac joint.
Applicable To
- Acute sprain of the sacroiliac joint
Excludes
- Chronic sacroiliac joint pain (M46.11)
Clinical Validation Requirements
- History of trauma
- Negative inflammatory markers
Coding Notes
Ensure documentation of trauma and absence of inflammatory markers.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right SI Joint Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M46.11.
Impact
Clinical: May lead to incorrect diagnosis and treatment., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Use standardized templates, Ensure complete test documentation
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Fails to meet specificity requirements., Data Quality: Impacts accuracy of clinical data.
Mitigation Strategy
Use M46.11 for confirmed sacroiliitis with inflammation.
Impact
Risk of audits due to non-specific coding of sacroiliitis.
Mitigation Strategy
Ensure detailed documentation of tests and imaging.
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 Right SI Joint Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right SI Joint Pain
Use these documentation templates to ensure complete and accurate documentation for Right SI Joint Pain. These templates include all required elements for proper coding and billing.
Chronic Right SI Joint Pain
Specialty: Pain ManagementRequired Elements
- Location and character of pain
- Provocation test results
- Imaging findings
- Response to injections
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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