Nonallopathic lesions, sacral region

This code describes somatic dysfunction specifically affecting the sacral region, which involves impaired or altered function of related components of the somatic system (skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements). It indicates a palpable finding of restricted or excessive motion, tenderness, tissue texture changes, and/or asymmetry in the sacrum.

This code is appropriate when a physician, particularly an osteopathic physician, documents findings of sacral somatic dysfunction during an examination. It is typically used to report the diagnosis that supports osteopathic manipulative treatment (OMT) targeting the sacral area. Documentation should clearly specify the sacral region as the site of the nonallopathic lesion.

• Ensure documentation explicitly states "sacral region" for the somatic dysfunction.
• Do not use this code for general back pain without specific findings of somatic dysfunction.
• This code is often a primary diagnosis when billing for osteopathic manipulative treatment (CPT codes 98925-98929).