M46.06
BillableSpinal enthesopathy, lumbar 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 lower back (lumbar spine), causing lower back pain and reduced mobility.
Coding Tips
- •Lumbar enthesopathy is one of the most common sites; verify documentation clearly identifies the lumbar region (L1-L5)
- •Consider if this is part of a systemic condition like ankylosing spondylitis, which would require an additional code
Clinical Significance
Lumbar spinal enthesopathy involves inflammation of ligament and tendon attachments in the lower back, often causing significant functional impairment and work disability. This condition frequently occurs as part of spondyloarthritis spectrum and requires evaluation for systemic inflammatory disease.
Documentation Requirements
- ✓Clinical evidence of lumbar entheseal inflammation
- ✓Imaging demonstrating lumbar spine entheseal changes
- ✓Documentation of lower back pain and stiffness patterns
- ✓Assessment of lumbar spine mobility and function
- ✓Evaluation for associated spondyloarthritis features
- ✓Response to anti-inflammatory and biologic therapy
- ✓Functional disability assessment using validated measures
- ✓Occupational impact and work capacity evaluation
Commonly Confused Codes
M46.05 — Thoracolumbar when thoracic involvement is also presentM46.07 — Lumbosacral when sacroiliac involvement is also presentM54.5 — Low back pain without entheseal inflammatory componentM45.A6 — Non-radiographic axial spondyloarthritis when primaryM47.816 — Lumbar spondylosis without inflammatory features
Code Hierarchy
└M46Other inflammatory spondylopathies└M46.0Spinal enthesopathy└M46.06Spinal enthesopathy, lumbar region
└M46.06Spinal enthesopathy, lumbar region