Pain Management Coding Alert

Published on Wed Feb 03, 2016 PDF

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, ICD-10 does not include the listing for facet syndrome in the Alphabetic Index. Because of this, ICD-10 guidelines direct you to “assign codes for the documented manifestations of the syndrome. Additional codes for manifestations that are not an integral part of the disease process may also be assigned when the condition does not have a unique code.”

Alternative plan: Consider reporting diagnosis code(s) for region-specific back pain when reporting facet syndrome. Possible codes can include M54.2 (Cervicalgia), M54.5 (Low back pain), and M54.6 (Pain in thoracic spine) as well as – or in place of – something from the M53.8~ (Other specified dorsopathies) subcategory. 

You may also consider spondylopathies falling within the M45-M49 range, picking up on category M47.~ (Spondylosis; Includes: arthrosis or osteoarthritis of spine, degeneration of facet joints), which happens to include degeneration of facet joints. Although this might seem like a logical choice, the code would not be applicable in a case of acute facet syndrome, where there would not be any signs of degeneration as such.