M46.26 — Osteomyelitis of vertebra, lumbar region
M46.26 is a billable, specific ICD-10-CM code for osteomyelitis of vertebra, lumbar region. It is valid for submission on a claim.
Risk adjustment
M46.26 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis0.479 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.
Medicare coverage
M46.26 is named in 9 Medicare coverage policies — 3 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing 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
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
How M46.26 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to M46.26.
- Osteomyelitis›vertebra›lumbar region
Related codes at this level
Codes that share M46.2. If M46.26 is not quite right, the correct code is usually one of these.
- M46.20Osteomyelitis of vertebra, site unspecified
- M46.21Osteomyelitis of vertebra, occipito-atlanto-axial region
- M46.22Osteomyelitis of vertebra, cervical region
- M46.23Osteomyelitis of vertebra, cervicothoracic region
- M46.24Osteomyelitis of vertebra, thoracic region
- M46.25Osteomyelitis of vertebra, thoracolumbar region
- M46.27Osteomyelitis of vertebra, lumbosacral region
- M46.28Osteomyelitis of vertebra, sacral and sacrococcygeal region
Questions about M46.26
- Is M46.26 a billable ICD-10-CM code?
- Yes. M46.26 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M46.26 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Spondylopathies (M45-M49).