by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA
July 28th, 2016
The facet joints are a pair of joints in the posterior aspect of the spine. Their proper name is zygapophysial joints. These joints can become inflamed due to trauma or overuse and cause back pain. This is called facet syndrome.
Unfortunately there was no ICD-9 code for this condition. However, diagnosis coding guidelines (in ICD-9 and ICD-10) inform us that codes with "other", "other specified", or "not elsewhere classified" in the description are for conditions that are not described elsewhere. In ICD-9 this led us to use 724.8 Other symptoms referable to the back. While this code said nothing about facets, it was still the most correct choice.
Unfortunately the GEMs mapping to ICD-10 for this code is M54.08 Panniculitis affecting region of neck and back, sacrococcygeal region. This is defined as inflammation of subcutaneous adipose tissue, which is not consistent with facet syndrome. This is a great example of how doctors who rely only on GEMs are headed for trouble. However, if the patient really has panniculitis, the this code is perfect.
There is, unfortunately, still no ICD-10 code for facet syndrome. But, M53.8- other specified dorsopathiescan be used just like the old ICD-9 code. It is the "other" code, which means it can be used for a specified condition like facet syndrome. Payers may want to review the records to find out why that code was used, but that should be no problem if the code is truly the best one for the case.
Another option is the M47- category, which includes "degeneration of facet joints". However, a patient may have an acute case of facet syndrome which does not include degeneration. And this code does not seem to address these acute cases.
The moral of the story is to learn how to use the code book. Its designers made it possible to code for just about anything, even when there is not a code that matches every patient. Consider signing up for the ChiroCode HelpDesk where you can ask ChiroCode's coding experts for help with things like this.