ICD-10 Coding for Sacroiliac Joint Disease(M46.1, S33.6)
Complete ICD-10-CM coding and documentation guide for Sacroiliac Joint Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sacroiliac Joint Disease
M46-M53Primary Range
Other inflammatory spondylopathies and dorsopathies
This range includes codes for inflammatory conditions affecting the sacroiliac joint, such as 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 |
|---|---|---|---|
| M46.1 | Sacroiliitis, not elsewhere classified | Use for confirmed inflammatory sacroiliitis with supporting imaging or lab results. |
|
| S33.6 | Sprain of sacroiliac joint | Use for acute traumatic injuries 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 sacroiliac joint disease
Essential facts and insights about Sacroiliac Joint Disease
Primary ICD-10-CM Codes for sacroiliac joint disease
Decision Criteria
clinical Criteria
- MRI shows bone marrow edema in the SI joint.
documentation Criteria
- Documented positive HLA-B27 test.
Applicable To
- Inflammatory sacroiliitis
Excludes
- Ankylosing spondylitis (M45.9)
Clinical Validation Requirements
- MRI showing bone marrow edema
- Positive HLA-B27 with SI joint erosion
Code-Specific Risks
- Risk of denial if laterality is not specified when documented.
Coding Notes
- Ensure documentation includes laterality and specific clinical findings.
S33.6 - Sprain of sacroiliac joint
Use for acute traumatic injuries to the sacroiliac joint.
Applicable To
- Acute sprain of the sacroiliac joint
Clinical Validation Requirements
- Mechanism of injury documented
- Positive thigh thrust test
Coding Notes
Ensure documentation includes the mechanism of injury and specific tests.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Biomechanical lesions, not elsewhere classified
M99.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sacroiliac Joint Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M46.1.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Use specific clinical terms and test results., Include imaging findings and detailed physical exam notes.
Impact
Reimbursement: May lead to claim denials if specificity is not provided., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation of the patient's condition.
Mitigation Strategy
Specify whether the disorder is inflammatory or mechanical and document accordingly.
Impact
Claims with M46.1 without supporting imaging or lab results.
Mitigation Strategy
Ensure documentation includes MRI or lab results supporting sacroiliitis.
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 Sacroiliac Joint Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sacroiliac Joint Disease
Use these documentation templates to ensure complete and accurate documentation for Sacroiliac Joint Disease. These templates include all required elements for proper coding and billing.
Chronic Sacroiliac Joint Pain
Specialty: Pain ManagementRequired Elements
- Subjective pain description
- Objective physical exam findings
- Imaging results
- Treatment plan
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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