M46.58

Billable

Other infective spondylopathies, sacral and sacrococcygeal region

HCC Category Mapping

V24HCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.307

ESRDHCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.000

What This Code Means

A spinal infection in the sacral and sacrococcygeal region at the base of the spine, affecting the lowest vertebrae and tailbone area.

Coding Tips

•This region is less commonly infected; ensure diagnosis is well-documented with imaging confirmation
•Consider associated complications such as abscess formation or neurological deficits

Clinical Significance

Non-pyogenic sacral and sacrococcygeal infections are rare conditions that may be associated with immunocompromise or specific geographic exposures. The limited blood supply to this region often complicates treatment and may require prolonged antimicrobial therapy.

Documentation Requirements

✓Sacral and sacrococcygeal region involvement
✓Non-bacterial infectious organism identification
✓Imaging of sacral region infection
✓Assessment for genitourinary involvement
✓Immunocompromised status documentation
✓Geographic or exposure risk factors
✓Response to targeted antimicrobial therapy
✓Pelvic function assessment

Commonly Confused Codes

M46.38 — Pyogenic sacral discitis when bacterial etiology M46.57 — Lumbosacral region when at L5-S1 junction M46.88 — Other inflammatory spondylopathies when non-infectious N34.1 — Urethritis when genitourinary symptoms predominate

Code Hierarchy

└M46Other inflammatory spondylopathies └M46.5Other infective spondylopathies └M46.58Other infective spondylopathies, sacral and sacrococcygeal region

└M46.58Other infective spondylopathies, sacral and sacrococcygeal region