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Chiropractic Coding & Compliance Alert

Reader Question:

How to Code for a Facet Syndrome?

Question: Please guide us through the codes for facet syndrome in ICD-10-CM.

Oklahoma Subscriber

Answer: Facet joints are a pair of joints present in the posterior aspect of the spine; they are common sources of neck and lower back pain and also are known as the zygapophyseal joint. When these joints become inflamed due to trauma or overuse, the patient suffers from what is called facet syndrome.

ICD-9-CM never had a code specifically for this condition. As per the diagnosis coding guidelines (in ICD-9 and ICD-10), codes with “other,” “other specified,” or “not elsewhere classified” are for conditions that are not described elsewhere. Therefore, in ICD-9, we used 724.8 (Other symptoms referable to the back) as the nearest option for the condition. However, the ICD-10 GEM mapping for 724.8 leads to M54.08 (Panniculitis affecting region of neck and back, sacrococcygeal region) – which is not accurate.

Way out: It is a better idea to choose M53.8~ (Other dorsopathies). It is the “other” code, which means it can be used for a specified condition like facet syndrome. With good documentation, this code would fare better than M54.08 if presented for payer scrutiny.

You may also consider spondylopathies falling within the M45-M49 range, picking up on M47.~ category, (Spondylosis, Includes: arthrosis or osteoarthritis of spine, degeneration of facet joints), which happens to include degeneration of facet joints. A logical pick no doubt, but this code would not be applicable in a case of acute facet syndrome, where there would not be any signs of degeneration as such.