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M53.3
ICD-10-CM
SI Joint Pain

Find information on SI joint pain diagnosis, including clinical documentation tips, ICD-10 codes (S33.1, M54.6), medical coding guidelines, and healthcare provider resources. Learn about sacroiliac joint dysfunction, pain management, and treatment options. Explore accurate diagnosis criteria and documentation best practices for SI joint pain.

Also known as

Sacroiliac Joint Pain
SI Dysfunction
si pain
+1 more

Diagnosis Snapshot

Key Facts
  • Definition : Pain in the sacroiliac joints connecting the spine and pelvis.
  • Clinical Signs : Buttock pain, lower back pain, leg pain, stiffness, pain with activity.
  • Common Settings : Physical therapy, chiropractic, pain clinics, orthopedics, rheumatology.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M53.3 Coding
M25.5

Pain in joint involving lower back

Pain localized to the sacroiliac joint.

S33.1

Sprain and strain of sacroiliac joint

Injury to the sacroiliac ligaments causing pain.

M54.6

Pain in thoracic spine

Referred pain from SI joint issues felt in the upper back.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the SI joint pain traumatic?

  • Yes

    Dislocation/subluxation?

  • No

    Is there inflammation?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Sacroiliac joint pain
Lumbosacral sprain/strain
Piriformis syndrome

Documentation Best Practices

Documentation Checklist
  • SI joint pain diagnosis documentation
  • Laterality: Left, Right, or Bilateral
  • Pain characteristics: Location, quality, radiation
  • Provocative/palliative factors: Movements/positions
  • Physical exam findings: Tenderness, ROM limitations
  • Diagnostic tests (if performed): X-ray, MRI, injection

Coding and Audit Risks

Common Risks
  • Unspecified SI Joint Pain

    Coding M54.9 (Unspecified SI joint pain) when more specific diagnoses like inflammation or osteoarthritis are documented, impacting reimbursement and data accuracy.

  • SI Joint vs. Lumbar Spine

    Misdiagnosis between SI joint pain and lumbar spine conditions can lead to incorrect codes (e.g., M54 vs. M40-M54), affecting quality metrics.

  • Lacking Laterality Documentation

    Missing documentation specifying right, left, or bilateral SI joint involvement necessitates defaulting to unspecified codes, hindering accurate tracking and trending.

Mitigation Tips

Best Practices
  • Document SI joint pain etiology for accurate ICD-10 coding (M54.6).
  • Correlate physical exam findings with imaging results for CDI of SI joint dysfunction.
  • Specify pain characteristics, location, and radiation for improved medical coding accuracy.
  • Use standardized terminology for SI joint injections for compliant billing (CPT 27096).
  • Review documentation for clarity and completeness to support medical necessity for SI joint treatment.

Clinical Decision Support

Checklist
  • 1. Fortin finger test positive?
  • 2. Pain with SI joint palpation/provocation?
  • 3. Consider imaging (X-ray/MRI) if needed.
  • 4. Exclude lumbar spine, hip pathology.

Reimbursement and Quality Metrics

Impact Summary
  • SI Joint Pain reimbursement hinges on accurate ICD-10 coding (M54.6) and proper documentation of medical necessity for procedures like injections or radiofrequency ablation.
  • Coding errors for SI Joint Pain can lead to claim denials, impacting revenue cycle management and hospital reimbursement rates. Proper use of modifiers like -59 or -XU is crucial.
  • Quality metrics for SI Joint Pain management include pain reduction, functional improvement, and patient satisfaction. Accurate coding facilitates data analysis for quality reporting.
  • Tracking SI Joint Pain diagnoses, treatments, and outcomes using appropriate codes improves data integrity for hospital reporting and value-based care initiatives.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code SI joint pain specifically
  • Document pain location, laterality
  • Fortin Finger test supports diagnosis
  • Consider imaging for confirmation
  • Exclude lumbar spine pathologies

Documentation Templates

Patient presents with complaints consistent with sacroiliac (SI) joint pain.  Onset of pain is described as [onset: e.g., gradual, sudden], located in the [location: e.g., lower back, buttock, groin, thigh], and characterized as [character: e.g., sharp, dull, aching, throbbing].  Pain is [exacerbating factors: e.g., aggravated by prolonged standing, sitting, bending, twisting, walking, climbing stairs] and [relieving factors: e.g., relieved by rest, ice, heat, medication].  Patient denies [associated symptoms: e.g., numbness, tingling, weakness, bowel or bladder dysfunction] radiating down the leg.  Physical examination reveals [physical exam findings: e.g., tenderness to palpation over the SI joint, positive FABER test, positive Gaenslen's test, limited lumbar range of motion].  Differential diagnosis includes lumbar radiculopathy, piriformis syndrome, and hip osteoarthritis.  Assessment: Sacroiliac joint dysfunction (ICD-10 code: M53.1).  Plan: Conservative management including [treatment plan: e.g., physical therapy focusing on core strengthening and stabilization exercises, NSAIDs for pain relief, SI joint belt for support, patient education on proper body mechanics].  Follow-up scheduled in [duration: e.g., 2 weeks] to assess response to treatment.  Consider referral to pain management specialist or orthopedist if symptoms persist or worsen.