M45.1

M45.1: Ankylosing spondylitis of occipito-atlanto-axial region

Billable / specific codeICD-10-CM

M45.1 is a billable, specific ICD-10-CM code for ankylosing spondylitis of occipito-atlanto-axial region. It is valid for submission on a claim.

Check M45.1 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above M45.1

A category’s note binds every code beneath it.

Written on M45: Ankylosing spondylitis

arthropathy in Reiter's disease (M02.3-)
juvenile (ankylosing) spondylitis (M08.1)

Excludes2 inherited from the categories above M45.1

Not part of this code, but both may be coded when both are present.

Written on M45: Ankylosing spondylitis

Behçet's disease (M35.2)

Other codes that can never be billed with M45.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

G55Nerve root and plexus compressions in diseases classified elsewhere
M05Rheumatoid arthritis with rheumatoid factor

Risk adjustment

M45.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 93 Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders0.617 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

M45.1 is named in 17 Medicare coverage policies: 10 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered