ICD-10-CM · Spine

M46.54

Infectious spinal disease affecting the thoracic vertebrae (T1–T12) caused by a pathogen other than those classified under osteomyelitis of vertebra (M46.2) or pyogenic intervertebral disc infection (M46.3).

Verified May 8, 2026 · 5 sources ↓

Status: Billable
Chapter: 13
Related CPT: 15
Region: Spine

Drawn from CDCICD10DataAAPCFindacode

Documentation tips

What should appear in the chart to support M46.54.

Source · Editorial brief grounded in 5 cited references ↓

Specify the thoracic region explicitly (T1–T12) in the clinical note — 'thoracic spine infection' maps directly to M46.54, while 'spinal infection NOS' drops to unspecified M46.50.
Document the identified or suspected organism (bacterial genus/species, fungal, parasitic) so a B95–B97 causative agent code can be assigned alongside M46.54 per tabular instructions.
Record MRI or CT imaging findings — epidural involvement, endplate erosion, disc space narrowing, or paraspinal abscess — to substantiate medical necessity for advanced imaging and procedural billing.
If conservative treatment (antibiotics, bracing) has been trialed, document duration and response; this supports medical necessity for surgical intervention such as debridement or fusion.
Distinguish this from vertebral osteomyelitis (M46.24, thoracic) and pyogenic disc infection (M46.34, thoracic) — those codes take priority when the pathology fits their definitions.

Related CPT procedures

Procedure codes commonly billed with M46.54. Linking the right diagnosis to the right procedure is what establishes medical necessity.

Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis

22532 $1,732.17

Spinal fusion at a single thoracic vertebral segment using the lateral extracavitary approach, which provides a wide posterolateral corridor to the anterior and middle columns without entering the thoracic cavity. Includes minimal discectomy to prepare the interspace for fusion.

22533 $1,547.80

Spinal fusion of a lumbar vertebral segment performed through a lateral extracavitary approach, including minimal discectomy to prepare the interspace (not performed solely for decompression).

22534 $323.65

Add-on code for lateral extracavitary arthrodesis at each additional thoracic or lumbar vertebral segment beyond the first.

22600 $1,282.93

Posterior or posterolateral cervical spinal fusion at a single interspace below C2, performed through a posterior approach to achieve bony arthrodesis.

22610 $1,255.54

Single-level posterior or posterolateral thoracic spine arthrodesis using a transverse process technique

22612 $1,467.64

Posterior or posterolateral lumbar arthrodesis of a single interspace, performed via a posterior approach with bone graft and typically pedicle screw fixation to achieve vertebral segment fusion.

22630 $1,510.72

Posterior interbody arthrodesis of a single lumbar interspace, including laminectomy and/or discectomy performed to prepare the interspace for fusion rather than for decompression.

22800 $1,312.99

Posterior spinal arthrodesis for deformity correction spanning up to 6 vertebral segments, with or without application of a body cast.

72070 $33.07

Two-view radiologic examination of the thoracic spine, including AP and lateral projections of the 12 thoracic vertebrae.

72081 $44.09

Single-view radiologic examination of the entire spine, capturing thoracic and lumbar regions and optionally including cervical, skull, and sacral segments — typically ordered for scoliosis evaluation or global spinal alignment assessment.

72082 $71.81

Radiologic examination of the entire thoracic and lumbar spine, capturing 2 or 3 views; skull, cervical, and sacral spine included when performed.

20605 $57.12

Aspiration and/or injection of an intermediate joint or bursa — such as the wrist, elbow, ankle, acromioclavicular joint, or olecranon bursa — performed without ultrasound guidance.

72072 View procedure details

72074 View procedure details

62323 View procedure details

Common coding pitfalls

The recurring mistakes coders make with M46.54 and adjacent codes.

Source · Editorial brief grounded in CDC ICD-10-CM tabular guidance, AAOS coding references, and cited references ↓

Assigning M46.54 when vertebral osteomyelitis is documented — use M46.24 (osteomyelitis of vertebra, thoracic region) instead; M46.54 is reserved for infective spondylopathies that don't meet osteomyelitis criteria.
Omitting the causative organism code (B95–B97) — the ICD-10-CM tabular carries a 'Use additional code' instruction at the M46.5 level; skipping it leaves the claim incomplete and audit-vulnerable.
Using M46.54 for thoracolumbar junction involvement without also assigning M46.55 (thoracolumbar region) when documentation clearly spans both regions.
Defaulting to M46.50 (site unspecified) when the operative or imaging report specifies thoracic involvement — the specificity is available and should be coded.

Clinical context

Source · Editorial summary grounded in 5 cited references ↓

M46.54 covers infective spondylopathies of the thoracic spine that don't fit the more specific categories of vertebral osteomyelitis or pyogenic discitis. This includes bacterial, fungal, parasitic, or other microbial infections involving the thoracic spinal structures when the organism or exact pathological process doesn't map to a narrower code. Typical clinical scenarios include granulomatous infections (e.g., brucellosis-related spondylitis, fungal spondylitis) and other non-pyogenic bacterial spondylitis localized to T1–T12.

The parent category M46.5 spans six site sub-codes (M46.50 through M46.56) to capture infective spondylopathies at each spinal region. If the infection spans multiple contiguous regions, code each affected region separately — there is no combination code for multilevel involvement. If the thoracic region is involved along with, say, the thoracolumbar junction, also assign M46.55.

Always code the causative organism as an additional code when documented — the tabular list instructs 'use additional code (B95–B97) to identify infectious agent.' Failing to add the organism code is an audit risk and may trigger a medical necessity denial from payers who require specificity on infectious diagnoses.

Sibling codes

Other billable codes under M46.5 (laterality / anatomic variants).

M46.53

Other infective spondylopathies, cervicothoracic region

M46.51

Oth infective spondylopathies, occipito-atlanto-axial region

M46.55

Other infective spondylopathies, thoracolumbar region

M46.59

Other infective spondylopathies, multiple sites in spine

M46.58

Oth infective spondylopathies, sacr/sacrocygl region

M46.50

Other infective spondylopathies, site unspecified

M46.57

Other infective spondylopathies, lumbosacral region

M46.52

Other infective spondylopathies, cervical region

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What distinguishes M46.54 from M46.24 (osteomyelitis of vertebra, thoracic)?

M46.24 is used when infection is specifically identified as osteomyelitis of the thoracic vertebral body. M46.54 applies to other infective processes involving the thoracic spine — such as granulomatous or fungal spondylitis — where the pathology doesn't meet the definition of vertebral osteomyelitis or pyogenic discitis.

02Do I need a second code to identify the organism?

Yes. The ICD-10-CM tabular list includes a 'Use additional code (B95–B97)' instruction at the M46.5 parent level. Assign the appropriate organism code (e.g., B96.89 for other specified bacterial agents) whenever the causative pathogen is documented.

03Can M46.54 be used for tuberculous spondylitis of the thoracic spine?

No. Tuberculous spondylitis is classified under A18.01 (tuberculosis of spine), not M46.54. The M46.5x codes cover infective spondylopathies not classified elsewhere — tuberculosis has its own code in Chapter 1 (A00–B99).

04What if the infection spans both the thoracic and thoracolumbar regions?

Assign both M46.54 (thoracic) and M46.55 (thoracolumbar) when documentation and imaging confirm involvement of both regions. There is no single combination code for multilevel infective spondylopathy.

05Is M46.54 appropriate for a postoperative spinal infection at the thoracic level?

Postoperative infections are typically coded with T84.60xA–T84.69xA (infection due to internal fixation device) or T81.40xA (infection following a procedure), with M46.54 as an additional code if the infective spondylopathy itself is documented. Sequence the complication code first per ICD-10-CM guidelines for postprocedural complications.

06Which imaging CPT codes pair with M46.54 for thoracic spine infection workup?

Thoracic spine X-ray series (72070–72074, 72081–72082) and MRI thoracic spine with or without contrast (72146, 72147) are the standard imaging pairings. Ensure the order and report document thoracic region specificity to match the diagnosis code.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01CDC ICD-10-CM Tabular List 2026 (effective Oct 1, 2025)
02
icd10data.com
https://www.icd10data.com/ICD10CM/Codes/M00-M99/M45-M49/M46-/M46.54
03
aapc.com
https://www.aapc.com/codes/icd-10-codes/M46
04
findacode.com
https://www.findacode.com/icd-10-cm/m46.54-infective-spondylopathies-thoracic-region-icd10cm-code.html
05
cdc.gov
https://www.cdc.gov/nchs/icd/icd-10-cm/index.html

Mira AI Scribe

Mira AI Scribe captures spinal region (thoracic, T1–T12), identified or suspected organism, imaging findings (MRI/CT endplate erosion, disc space changes, paraspinal abscess), and prior treatment course. That documentation drives the B95–B97 organism add-on code, prevents downcode to unspecified M46.50, and protects against medical necessity denials on surgical or advanced imaging claims.

See how Mira captures M46.54 documentation