ICD-10-CM · Spine

M48.08

Narrowing of the spinal canal at the sacral or sacrococcygeal level, compressing nerve roots in the terminal spinal column.

Verified May 8, 2026 · 7 sources ↓

Status: Billable
Chapter: 13
Related CPT: 10
Region: Spine

Drawn from CDCICD10DataAAPCKzanowSprypt

Documentation tips

What should appear in the chart to support M48.08.

Source · Editorial brief grounded in 7 cited references ↓

Explicitly name the region: 'sacral stenosis' or 'sacrococcygeal spinal stenosis' — generic 'low back stenosis' without localization forces a drop to M48.00.
Include MRI or CT findings that confirm canal narrowing at the sacral level, referencing the specific vertebral segment (e.g., S1-S3) and degree of narrowing.
Document symptom laterality and character — unilateral vs. bilateral leg symptoms, presence of bowel/bladder dysfunction — to support medical necessity and downstream procedure coding.
Note conservative treatment history (physical therapy, epidural steroid injections, NSAIDs) prior to any surgical or interventional referral to establish medical necessity.
If neurogenic claudication is present and co-documented, add it as an additional diagnosis; M48.08 does not carry a subcode for neurogenic claudication the way M48.06 does.
Provider using the term 'caudal stenosis' with sacral localization maps to M48.08 per the Applicable To note under parent M48.0 — flag this synonym for your providers.

Related CPT procedures

Procedure codes commonly billed with M48.08. 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.

72100 $40.42

Radiologic examination of the lumbosacral spine capturing two or three views, used to evaluate the lumbar vertebrae and sacrum for injury, degeneration, or structural abnormality.

72120 $42.09

Radiologic examination of the lumbosacral spine using bending views only, minimum of four views, to assess spinal flexibility and alignment.

27096 $175.69

Injection into the sacroiliac joint with fluoroscopic or CT image guidance, including arthrography when performed.

63030 $898.15

Single-interspace lumbar laminotomy with nerve root decompression, including partial facetectomy, foraminotomy, and/or herniated disc excision performed via open surgical technique.

63047 $1,065.49

Lumbar laminectomy at a single vertebral segment that also includes facetectomy and foraminotomy for decompression of the spinal cord, cauda equina, and/or nerve roots — unilateral or bilateral.

63056 $1,404.84

Lumbar spinal cord and nerve root decompression via transpedicular approach, single segment, including transfacet or lateral extraforaminal variants for far lateral disc herniations.

64999 View procedure details

22899 View procedure details

Common coding pitfalls

The recurring mistakes coders make with M48.08 and adjacent codes.

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

Confusing M48.07 (lumbosacral) with M48.08 (sacral/sacrococcygeal): if stenosis is documented at L5-S1 or the lumbosacral junction, use M48.07 — M48.08 is reserved for the sacrum and coccyx distal to that junction.
Defaulting to M48.00 (site unspecified) when the provider documents 'sacral' stenosis — M48.08 is available and specific; unspecified codes invite payer scrutiny and potential downcoding.
Applying M48.08 based on symptom distribution alone (e.g., sacral pain) without imaging or provider attestation to sacral-level canal narrowing — diagnosis must be supported by objective findings.
Misreading 'caudal stenosis' as referring to the cauda equina at the lumbar level; when the provider specifies sacral localization, M48.08 applies per the M48.0 Applicable To annotation.
Omitting additional codes for associated conditions such as spondylolisthesis, degenerative disc disease, or neurogenic bladder — M48.08 captures the stenosis only, not comorbid structural or functional diagnoses.

Clinical context

Source · Editorial summary grounded in 7 cited references ↓

M48.08 is the only billable code for spinal stenosis localized to the sacral and sacrococcygeal region. Use it when imaging or clinical documentation explicitly places the stenosis at the sacrum or coccyx — not the lumbosacral junction (M48.07) and not an unspecified spinal level (M48.00). The sacral and sacrococcygeal region sits distal to L5-S1; if the provider documents stenosis at that junction, M48.07 is the correct pick.

This code covers all canal-narrowing mechanisms at this level — degenerative, post-traumatic, congenital narrowing — without requiring the coder to distinguish central canal stenosis from foraminal stenosis. ICD-10-CM makes no such distinction within M48.0-. The parent annotation under M48.0 includes 'caudal stenosis' as an applicable term, so provider documentation using 'caudal stenosis' with sacral localization maps here.

Symptoms driving the encounter may include low sacral pain, buttock or perineal radiculopathy, lower-extremity numbness or weakness, or bowel/bladder dysfunction. Code any neurogenic claudication, myelopathy, or associated degenerative conditions with additional codes as supported by documentation. MS-DRG grouping lands in 551 (medical back problems with MCC) or 552 (without MCC).

Sibling codes

Other billable codes under M48.0 (laterality / anatomic variants).

M48.07

Spinal stenosis, lumbosacral region

M48.04

Spinal stenosis, thoracic region

M48.01

Spinal stenosis, occipito-atlanto-axial region

M48.02

Spinal stenosis, cervical region

M48.03

Spinal stenosis, cervicothoracic region

M48.00

Spinal stenosis, site unspecified

M48.05

Spinal stenosis, thoracolumbar region

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between M48.07 and M48.08?

M48.07 covers the lumbosacral region (the junction of L5 and S1), while M48.08 is specific to the sacral and sacrococcygeal region distal to that junction. The distinction depends on where the provider and imaging localize the stenosis — not on symptom distribution.

02Does M48.08 cover both central canal and foraminal stenosis at the sacral level?

Yes. ICD-10-CM makes no distinction between central canal stenosis and foraminal stenosis within the M48.0- family. M48.08 applies to either or both types when occurring at the sacral or sacrococcygeal level.

03Can I use M48.08 when the provider documents 'caudal stenosis'?

Yes, if the provider localizes the stenosis to the sacral region. The Applicable To note under parent code M48.0 lists 'caudal stenosis.' Confirm sacral-level localization in the documentation or imaging before assigning M48.08 rather than a more proximal code.

04Does M48.08 require a 7th-character extension?

No. M48.08 is an M-code (musculoskeletal disease) and does not use 7th-character encounter extensions. Those extensions apply to injury S-codes and to specific M48 fracture subcategories (M48.4- and M48.5-), not to M48.08.

05What imaging documentation is needed to support M48.08?

An MRI or CT report confirming canal narrowing at the sacral or sacrococcygeal level is the gold standard. The report should reference the specific segment(s) involved, the degree of narrowing, and any associated nerve root compression. X-ray findings alone may not be sufficient to confirm canal stenosis.

06Should I code neurogenic claudication separately when using M48.08?

Unlike M48.06 (lumbar), M48.08 has no sub-code for neurogenic claudication. If the provider documents neurogenic claudication in the context of sacral stenosis, code M48.08 for the stenosis and add a separate code for the claudication or neurological deficit as documented and supported.

07Which MS-DRGs does M48.08 group into?

M48.08 groups into MS-DRG 551 (Medical back problems with MCC) or MS-DRG 552 (Medical back problems without MCC) under MS-DRG v43.0, per the ICD-10-CM tabular grouping for this code.

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 anatomic level of stenosis from imaging reports (sacral segment, degree of canal narrowing), symptom laterality, neurological deficits, and documented conservative care history. This prevents downcoding to unspecified M48.00, avoids misassignment to the adjacent lumbosacral code M48.07, and ensures the claim reflects the highest specificity supported by the encounter documentation.

See how Mira captures M48.08 documentation