ICD-10 Coding for Sacroiliac Syndrome(M53.3, M46.1, S33.6)
Complete ICD-10-CM coding and documentation guide for Sacroiliac Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sacroiliac Syndrome
M53-M54Primary Range
Other dorsopathies
This range includes codes for sacroiliac joint dysfunction and related conditions.
Spondylopathies
This range includes codes for inflammatory conditions like sacroiliitis and ankylosing spondylitis.
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 |
|---|---|---|---|
| M53.3 | Sacrococcygeal disorders, not elsewhere classified | Use for non-specific sacroiliac joint dysfunction without inflammatory or traumatic causes. |
|
| M46.1 | Sacroiliitis, not elsewhere classified | Use for confirmed inflammatory sacroiliac joint conditions. |
|
| S33.6 | Sprain of sacroiliac joint | Use for 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 syndrome
Essential facts and insights about Sacroiliac Syndrome
Primary ICD-10-CM Codes for sacroiliac syndrome
Decision Criteria
clinical Criteria
- Presence of mechanical SI joint pain without inflammatory markers.
Applicable To
- SI joint dysfunction
- Pelvic instability
Clinical Validation Requirements
- Documented SI joint pain with mechanical dysfunction
- Positive provocation tests
Code-Specific Risks
- Risk of unspecified coding if laterality is not documented.
Coding Notes
- Ensure documentation specifies the cause and laterality to avoid unspecified codes.
M46.1 - Sacroiliitis, not elsewhere classified
Use for confirmed inflammatory sacroiliac joint conditions.
Applicable To
- Inflammatory sacroiliac joint pain
Excludes
- Ankylosing spondylitis (M45.9)
Clinical Validation Requirements
- MRI confirmation of sacroiliitis
- Positive HLA-B27 test
Coding Notes
Ensure imaging and lab results are documented to support inflammatory diagnosis.
S33.6 - Sprain of sacroiliac joint
Use for traumatic injuries to the sacroiliac joint.
Applicable To
- Traumatic sacroiliac joint sprain
Clinical Validation Requirements
- Documented traumatic event leading to SI joint pain
- Positive physical exam findings
Coding Notes
Ensure documentation includes details of the traumatic event and resulting injury.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sacroiliac Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M53.3.
Impact
Clinical: Leads to unspecified diagnosis, affecting treatment decisions., Regulatory: Non-compliance with ICD-10 coding guidelines., Financial: Potential for denied claims due to unspecified coding.
Mitigation Strategy
Always document laterality in clinical notes., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality affecting clinical decision-making.
Mitigation Strategy
Ensure documentation includes cause, laterality, and specific findings.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with procedural coding guidelines., Data Quality: Inaccurate procedural data affecting treatment records.
Mitigation Strategy
Use 27096 for SI joint injections with image guidance.
Impact
High risk of audits due to unspecified codes.
Mitigation Strategy
Ensure complete documentation of laterality and etiology.
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 Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sacroiliac Syndrome
Use these documentation templates to ensure complete and accurate documentation for Sacroiliac Syndrome. These templates include all required elements for proper coding and billing.
Chronic Sacroiliac Joint Dysfunction
Specialty: OrthopedicsRequired Elements
- Symptom duration
- Physical exam findings
- Imaging results
- Failed treatments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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