M46.04
BillableSpinal enthesopathy, thoracic region
HCC Category Mapping
V24HCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.307ESRDHCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.000What This Code Means
Inflammation of the tendons and ligaments where they attach to the bones in the mid-back (thoracic spine), causing pain and stiffness in that region.
Coding Tips
- •Enthesopathy refers to inflammation at the enthesis (attachment point of tendons/ligaments to bone); ensure the thoracic region is clearly documented
- •Differentiate from other spinal conditions by confirming the inflammation is at the attachment sites rather than the vertebral bodies themselves
Clinical Significance
Thoracic spinal enthesopathy affects ligament and tendon attachments in the mid-back region, potentially impacting respiratory mechanics and posture. This condition often requires evaluation for underlying spondyloarthritis and may predict development of thoracic kyphosis if untreated.
Documentation Requirements
- ✓Clinical evidence of thoracic entheseal inflammation
- ✓Imaging showing thoracic spine entheseal changes
- ✓Assessment of thoracic spine mobility and chest expansion
- ✓Documentation of costovertebral joint involvement if present
- ✓Evaluation for respiratory function impact
- ✓Response to anti-inflammatory and targeted therapy
- ✓Postural assessment and kyphosis measurement
- ✓Screening for associated inflammatory conditions
Commonly Confused Codes
M46.03 — Cervicothoracic when neck involvement is also presentM46.05 — Thoracolumbar when lower back is also involvedM54.6 — Thoracic pain without entheseal inflammatory componentM45.A4 — Non-radiographic axial spondyloarthritis when primaryM47.814 — Thoracic spondylosis without inflammatory features
Code Hierarchy
└M46Other inflammatory spondylopathies└M46.0Spinal enthesopathy└M46.04Spinal enthesopathy, thoracic region
└M46.04Spinal enthesopathy, thoracic region