M99.04 Segmental and somatic dysfunction of sacral region

ICD10CM code

#### Name of the Condition
- Segmental and somatic dysfunction of the sacral region
- ICD Code: M99.04

#### Summary
Segmental and somatic dysfunction of the sacral region refers to abnormal function of the sacral part of the spine, affecting movement and possibly leading to pain or discomfort in the lower back and pelvis area.

#### Causes
- Physical trauma or injury to the lower back or pelvis.
- Poor posture or repetitive strain.
- Arthritis or degenerative disc disease.
- Muscular imbalances or inflammation.

#### Risk Factors
- Advancing age.
- Occupations involving heavy lifting or prolonged sitting.
- History of lower back injuries.
- Sedentary lifestyle.

#### Symptoms
- Pain or discomfort in the sacral area.
- Limited range of motion in the lower back.
- Muscle spasms or stiffness.
- Sensations of tingling or numbness in the surrounding regions.

#### Diagnosis
- Physical examination by a healthcare professional.
- History taking focusing on lifestyle and physical activities.
- Imaging studies like X-rays or MRI to rule out other conditions.

#### Treatment Options
- Physical therapy to improve posture and flexibility.
- Chiropractic adjustments to realign spinal segments.
- Pain-relief medications like NSAIDs.
- In some cases, acupuncture or massage therapy.

#### Prognosis and Follow-Up
- Most individuals experience improvement with appropriate treatment and lifestyle modification.
- Regular follow-up with a healthcare provider is crucial for monitoring progress and preventing recurrence.

#### Complications
- Chronic pain and reduced mobility if not treated.
- Potential for developing compensatory issues elsewhere in the body due to altered movement patterns.

#### Lifestyle & Prevention
- Maintaining an active lifestyle with regular exercise.
- Practicing proper ergonomics at work and home.
- Gradual strengthening of core muscles to support the back.

#### When to Seek Professional Help
- Persistent or worsening pain despite home treatments.
- Significant limitation in daily activities or functions.
- Development of new neurological symptoms like weakness or severe numbness.

#### Additional Resources
- American Chiropractic Association (ACA) [website](https://www.acatoday.org/)
- National Institute of Neurological Disorders and Stroke [website](https://www.ninds.nih.gov/Disorders)

#### Tips for Medical Coders
- Ensure that coding includes the specific area affected (sacral region).
- Cross-check documentation for any coexisting conditions or injuries.
- Avoid confusion with similar codes for different spinal regions.

Medical Policies and Guidelines for Segmental and somatic dysfunction of sacral region

Related policies from health plans

Similar Codes