ICD-10 Coding for Spondyloarthropathy(M45, M46.8, M46.1)
Complete ICD-10-CM coding and documentation guide for Spondyloarthropathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Spondyloarthropathy
M45-M46Primary Range
Spondyloarthropathies
This range includes codes for different types of spondyloarthropathies, including ankylosing spondylitis and non-radiographic axial spondyloarthritis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M45 | Ankylosing spondylitis | Use when X-ray shows sacroiliitis and patient meets clinical criteria for ankylosing spondylitis. |
|
| M46.8 | Non-radiographic axial spondyloarthritis | Use when MRI shows inflammation and clinical criteria for axial spondyloarthritis are met, but X-ray is negative. |
|
| M46.1 | Peripheral spondyloarthritis | Use when peripheral manifestations such as dactylitis or enthesitis are present. |
|
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 ankylosing spondylitis
Essential facts and insights about Spondyloarthropathy
Primary ICD-10-CM Codes for spondyloarthropathy
Decision Criteria
clinical Criteria
- Presence of bilateral sacroiliitis on X-ray
Applicable To
- Radiographic axial spondyloarthritis
Excludes
- Non-radiographic axial spondyloarthritis (M46.8)
Clinical Validation Requirements
- Bilateral grade ≥2 sacroiliitis on X-ray
- HLA-B27 positive
- Morning stiffness >30 mins
Code-Specific Risks
- Misclassification if X-ray findings are not documented.
Coding Notes
- Ensure X-ray findings are documented to support use of M45.
M46.8 - Non-radiographic axial spondyloarthritis
Use when MRI shows inflammation and clinical criteria for axial spondyloarthritis are met, but X-ray is negative.
Applicable To
- Axial spondyloarthritis without radiographic evidence
Excludes
- Ankylosing spondylitis (M45)
Clinical Validation Requirements
- Active sacroiliitis on MRI
- IBP ≥3 months
- Negative X-ray
- CRP elevation
Coding Notes
Ensure MRI findings are documented to support use of M46.8.
M46.1 - Peripheral spondyloarthritis
Use when peripheral manifestations such as dactylitis or enthesitis are present.
Applicable To
- Peripheral spondyloarthritis with enthesitis/dactylitis
Excludes
- Psoriatic arthritis (L40.5)
Clinical Validation Requirements
- Dactylitis (sausage digit)
- Enthesitis (Achilles/plantar fascia)
- Psoriasis
Coding Notes
Document specific peripheral symptoms to support use of M46.1.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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 Spondyloarthropathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M45.
Impact
Clinical: May lead to incorrect diagnosis and treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential denial of claims due to incomplete documentation.
Mitigation Strategy
Ensure HLA-B27 testing is ordered and results documented., Include HLA-B27 status in the assessment section.
Impact
Reimbursement: May lead to lower reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines for specificity., Data Quality: Reduces data quality and accuracy in patient records.
Mitigation Strategy
Specify the type of spondyloarthropathy using M45 or M46.8 based on clinical findings.
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Ensure detailed documentation of clinical findings and imaging results.
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 Spondyloarthropathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Spondyloarthropathy
Use these documentation templates to ensure complete and accurate documentation for Spondyloarthropathy. These templates include all required elements for proper coding and billing.
Rheumatology Progress Note
Specialty: RheumatologyRequired Elements
- Subjective symptoms
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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