ICD-10 Coding for Sacroiliac Pain(M46.1, M53.3, M99.0, S33.6)
Complete ICD-10-CM coding and documentation guide for Sacroiliac Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sacroiliac Pain
M46-M53Primary Range
Other inflammatory spondylopathies and dorsopathies
This range includes codes for inflammatory and non-inflammatory sacroiliac joint disorders.
Dislocation and sprain of joints and ligaments of lumbar spine and pelvis
This range includes codes for traumatic injuries to the sacroiliac joint.
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 when there is evidence of inflammatory sacroiliitis. |
|
| M53.3 | Sacroiliac joint dysfunction, not elsewhere classified | Use for non-inflammatory sacroiliac joint dysfunction. |
|
| M99.0 | Segmental and somatic dysfunction of sacroiliac region | Use for segmental dysfunction without trauma. |
|
| 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 pain
Essential facts and insights about Sacroiliac Pain
Primary ICD-10-CM Codes for sacroiliac pain
Decision Criteria
clinical Criteria
- Presence of inflammatory markers and positive imaging findings.
Applicable To
- Inflammatory sacroiliac joint pain
Excludes
- Non-inflammatory sacroiliac joint pain
Clinical Validation Requirements
- Unilateral/bilateral SIJ tenderness
- CRP/ESR elevation
- HLA-B27 positivity
Code-Specific Risks
- Misclassification if non-inflammatory causes are present
Coding Notes
- Ensure inflammatory markers are documented.
M53.3 - Sacroiliac joint dysfunction, not elsewhere classified
Use for non-inflammatory sacroiliac joint dysfunction.
Applicable To
- Mechanical sacroiliac joint pain
Excludes
- Inflammatory sacroiliac joint pain
Clinical Validation Requirements
- Pain localized to Fortin's point
- 3/5 positive provocation tests
Coding Notes
Document specific provocation tests used.
M99.0 - Segmental and somatic dysfunction of sacroiliac region
Use for segmental dysfunction without trauma.
Applicable To
- Somatic dysfunction of sacroiliac joint
Clinical Validation Requirements
- Restricted SIJ mobility on spring test
- Pelvic obliquity
Coding Notes
Ensure documentation of mobility tests.
S33.6 - Sprain of sacroiliac joint
Use for acute traumatic injuries to the sacroiliac joint.
Applicable To
- Traumatic sacroiliac joint pain
Clinical Validation Requirements
- Mechanism of injury
- Positive compression/distraction tests
Coding Notes
Document the mechanism of injury clearly.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sacroiliac Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M46.1.
Impact
Clinical: Ambiguity in treatment planning., Regulatory: Potential for claim denials., Financial: Delayed reimbursements.
Mitigation Strategy
Always specify left, right, or bilateral involvement.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M53.3 for non-inflammatory sacroiliac dysfunction.
Impact
Lack of documentation for image guidance can lead to audits.
Mitigation Strategy
Ensure all injection procedures are documented with image guidance.
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 Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sacroiliac Pain
Use these documentation templates to ensure complete and accurate documentation for Sacroiliac Pain. These templates include all required elements for proper coding and billing.
Chronic Sacroiliac Joint Pain
Specialty: Pain ManagementRequired Elements
- Pain location and radiation
- Provocation test results
- Imaging findings
- Injection response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Sacroiliac Pain? Ask your questions below.