ICD-10-CM · Spine

M47.28

Degenerative spinal disease (spondylosis) of the sacral and sacrococcygeal region with documented nerve root irritation or compression (radiculopathy).

Verified May 8, 2026 · 6 sources ↓

Status: Billable
Chapter: 13
Related CPT: 9
Region: Spine

Drawn from CDCICD10DataCMSHopkinsmedicineAAPC

Documentation tips

What should appear in the chart to support M47.28.

Source · Editorial brief grounded in 6 cited references ↓

Specify the region explicitly as 'sacral' or 'sacrococcygeal' in the note — vague low back or coccyx pain language will not support this code.
Document imaging findings (MRI or CT) showing spondylotic changes at the sacral level: osteophytes, foraminal narrowing, or degenerative endplate changes with nerve root involvement.
Record the radiculopathy findings separately: dermatomal distribution of symptoms (perineal, perianal, posterior leg), reflex changes, or EMG/nerve conduction results corroborating sacral nerve root compression.
If the degeneration spans the lumbosacral junction AND the sacrum, code each level separately (M47.27 + M47.28) only if both are distinctly documented and clinically relevant.
Note any prior conservative treatment — physical therapy, injections, chiropractic — to support medical necessity for advanced imaging or interventional procedures.

Related CPT procedures

Procedure codes commonly billed with M47.28. Linking the right diagnosis to the right procedure is what establishes medical necessity.

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

72148 $191.72

Non-contrast MRI of the lumbar spine used to evaluate disc pathology, spinal stenosis, nerve root compression, and other structural abnormalities without administration of contrast material.

72158 $318.31

MRI of the lumbar spinal canal and its contents performed first without contrast, then repeated after contrast administration for enhanced visualization.

99213 $95.19

Established patient office or outpatient visit requiring 20–29 minutes of total time or low-complexity medical decision-making.

99214 $135.61

Office visit for an established patient requiring moderate-complexity medical decision making (MDM), or 30–39 minutes of total provider time on the date of service.

99215 $192.39

Highest-level office or outpatient E/M visit for an established patient, qualifying via high-complexity medical decision making or 40–54 minutes of total provider time on the date of service.

97140 $27.72

Skilled, hands-on manual therapy techniques — including joint mobilization/manipulation, manual lymphatic drainage, and manual traction — applied to one or more body regions, billed per 15-minute unit.

72197 View procedure details

62323 View procedure details

64999 View procedure details

Common coding pitfalls

The recurring mistakes coders make with M47.28 and adjacent codes.

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

Using M47.28 when the documented level is lumbosacral (L5-S1 junction) — that belongs to M47.27, not M47.28.
Defaulting to M47.28 for nonspecific coccydynia (M53.3) or generalized low back pain (M54.50) when no structural spondylotic finding with nerve root involvement is documented.
Coding M47.28 without accompanying imaging documentation — payers including TRICARE have placed this code on low back pain imaging post-service claim review lists, meaning unsupported claims will be scrutinized.
Confusing spondylosis (M47.x) with spondylolisthesis (M43.1x) or spondylolysis (M43.0x) — these are distinct diagnoses requiring different codes even when they co-occur.
Omitting a more specific radiculopathy descriptor when the provider documents a named nerve root (e.g., S3 radiculopathy) — the clinical detail should drive the code selection and be reflected in the note.

Clinical context

Source · Editorial summary grounded in 6 cited references ↓

M47.28 captures spondylosis with radiculopathy localized to the sacral and sacrococcygeal spine — the segment between the lumbosacral junction and the coccyx. Use it when the provider has documented both the degenerative structural finding (osteophytes, disc space narrowing, facet arthropathy at the sacral level) and the resulting nerve root involvement. If the radiculopathy is documented at the lumbosacral junction rather than the sacrum proper, use M47.27 instead.

This is a rare but billable presentation. True sacral radiculopathy typically produces perineal, perianal, or posterior thigh/leg symptoms stemming from S1–S5 nerve roots. Imaging (MRI or CT of the sacrum/coccyx) documenting spondylotic changes compressing sacral nerve roots is required to justify the specificity of this code over a less specific alternative.

M47.28 appears on TRICARE/USFHP's Low Back Pain Imaging Policy (effective April 1, 2024) and on the CMS Medicare chiropractic services billing article (A56273) as a code supporting medical necessity. Payers will expect imaging documentation to back the claim. Do not use M47.28 for generic coccydynia or nonspecific low back pain — those require entirely different codes.

Sibling codes

Other billable codes under M47.2 (laterality / anatomic variants).

M47.20

Other spondylosis with radiculopathy, site unspecified

M47.25

Other spondylosis with radiculopathy, thoracolumbar region

M47.22

Other spondylosis with radiculopathy, cervical region

M47.26

Other spondylosis with radiculopathy, lumbar region

M47.23

Other spondylosis with radiculopathy, cervicothoracic region

M47.21

Oth spondylosis w radiculopathy, occipt-atlan-ax region

M47.27

Other spondylosis with radiculopathy, lumbosacral region

M47.24

Other spondylosis with radiculopathy, thoracic region

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between M47.27 and M47.28?

M47.27 applies to the lumbosacral region (the L5-S1 junction), while M47.28 applies to the sacral and sacrococcygeal region (S1–coccyx segment). The distinction rests on where imaging and clinical findings localize the spondylotic nerve root compression. When the provider documents lumbosacral, use M47.27. When documentation specifically identifies the sacrum or sacrococcygeal area, use M47.28.

02Does M47.28 require imaging to be billed?

Clinically, the diagnosis must be supported by imaging showing spondylotic changes at the sacral level. Practically, TRICARE/USFHP placed M47.28 on its Low Back Pain Imaging Post-Service Claim Review list (effective April 1, 2024), meaning claims submitted under this code are subject to retrospective review. MRI or CT documentation of sacral spondylosis with nerve root involvement is essential to withstand that scrutiny.

03Can M47.28 be used as a supporting diagnosis for chiropractic services under Medicare?

Yes. CMS Article A56273 (Billing and Coding: Chiropractic Services) lists M47.28 in Group 2 as a code that supports medical necessity for chiropractic manipulation. The clinical documentation must still reflect the sacral/sacrococcygeal spondylosis with radiculopathy finding.

04What symptoms should the note reflect to support M47.28?

Sacral radiculopathy typically produces symptoms in the S1–S5 distribution: perianal or perineal sensory changes, posterior thigh and leg pain, bladder or bowel sensory disturbance (though frank neurogenic bowel/bladder warrants additional coding), and reduced lower extremity reflexes. The note should link these symptoms to the spondylotic structural finding on imaging.

05Is M47.28 appropriate for coccydynia?

No. Coccydynia (pain localized to the coccyx without documented spondylotic radiculopathy) is coded M53.3. M47.28 requires both a degenerative spondylotic structural finding at the sacral or sacrococcygeal level and documented nerve root involvement. Use M53.3 when pain is coccyx-localized without those structural and radicular elements.

06Should M47.28 be coded alongside a radiculopathy code such as M54.4?

Generally no. When spondylosis with radiculopathy is coded to a site-specific M47.2x code, the radiculopathy is included in the combination code. Adding a separate M54.4x code for sciatica or lumbosacral radiculopathy would be redundant unless there is a distinct, separately documented radicular process at a different level.

07What imaging CPT codes are typically paired with M47.28?

MRI of the lumbar/sacral spine without contrast (72148), with contrast (72149), or with and without (72158) are the most common pairings. CT of the lumbar/sacral spine (72133) and sacrum/coccyx x-ray may also apply depending on the workup. Always confirm payer-specific imaging policy, especially under TRICARE.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the sacral or sacrococcygeal region designation, the specific nerve root symptoms (perineal numbness, posterior leg pain, bowel/bladder sensory changes), and the imaging findings (MRI/CT showing spondylotic foraminal narrowing or osteophytes at the sacral level) that distinguish M47.28 from the adjacent lumbosacral code M47.27. Precise region and radiculopathy documentation prevents downcoding to M47.20 (unspecified site) or a payer audit flag under TRICARE's low back pain imaging policy.

See how Mira captures M47.28 documentation