Learn the Ins and Outs of Reporting Facet Joint Syndrome

Tue, Mar 22, 2016 --

ICD-10, Reader Questions

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Facet joint syndrome is a common cause of back and neck pain. The facet joints, which are also called zygapophyseal joints, are located on the back of the spinal column, with two joints for each vertebra, one on each side of the spine. Zygapophyseal joints, also called Z joints, enable the back to flex, twist, and bend. These are synovial joints, covered with articular cartilage just like other joints such as the knees and hips. And just like with knees and hips, osteoarthritis can develop in the Z joints or facet joints, causing facet joint syndrome.

Reporting Facet Joint Syndrome Diagnoses

The problem for coders with this common diagnosis is deciding how to report it. There is no clearly specified diagnosis code for facet joint syndrome. ICD-9-CM never had a code specifically for this condition, and neither does ICD-10-CM. (It’s hard to imagine that ICD-10-CM actually left out a condition, but there we are.) In ICD-9-CM and ICD-10-CM, the guidelines instruct coders to report conditions not described elsewhere in the code set by using codes with “other,” “other specified,” or “not elsewhere classified.”

Here’s a GEM to Avoid at All Costs!

In ICD-9, we used 724.8 (Other symptoms referable to the back) as the nearest option for the facet joint syndrome. However, the ICD-10 GEM mapping for 724.8 leads to M54.08 (Panniculitis affecting region of neck and back, sacrococcygeal region). This translation is just plain wrong for facet joint syndrome. As you know, the facet joints are synovial joints—this is articular tissue, not soft tissue! Panniculitis refers to inflammation of the fatty layer of tissue under the skin, formally called panniculus adiposus. Here’s a case where you definitely do not want to use the GEM map from ICD-9, unless your patient really does have a case of inflamed neck or back fat!

“Other” Codes to Choose From

So what to do? ICD-10-CM coding 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.”

If you’re looking for a group of appropriate “other” codes, consider M53.8- (Other dorsopathies), which is certainly a better choice than M54.08 for facet joint syndrome! Other options include the spondylopathies in the M45 to M49 range. For example, the M47.- category (Spondylosis, Includes: arthrosis or osteoarthritis of spine, degeneration of facet joints) directly mentions the condition we’re looking for, osteoarthritis of spine and/or degeneration of facet joints. For this reason, an appropriate code from this category could be a logical pick.

Diagnosis documentation that uses terms like osteoarthritis or degeneration, as in degenerative joint disease, clues you in that the M47.- category could be the right choice. But watch out! If your documentation specifies acute facet joint syndrome, steer away from M47.-. Acute facet syndrome would not show signs of degeneration, so this code would be inappropriate for reporting an acute case.

What About You?

Does your practice deal with facet joint syndrome frequently? If so, are there any tips for successful reimbursement with this condition that we forgot? Let us know in the comment box below. We love to hear from you!

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Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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