100% · General spine formula, 100 percent
Unfavorable ankylosis of the entire spine is the published condition in this row. Read the regulatory ankylosis definition and segment rules.
Unfavorable ankylosis of the entire spine
Thoracolumbar spine — DC 5235, DC 5236, DC 5237, DC 5238, DC 5239, DC 5240, DC 5241, DC 5242, DC 5243
The general spine formula uses motion, ankylosis and other specified findings. Qualifying intervertebral disc syndrome (IVDS) can use an alternative formula based on incapacitating-episode duration.
Diagnostic-code references
How the criteria work
50% · General spine formula, 50 percent
This row concerns unfavorable ankylosis of the entire thoracolumbar spine. It is not a motion-angle tier.
Unfavorable ankylosis of the entire thoracolumbar spine
40% · General spine formula, 40 percent
The semicolon-separated alternatives include a cervical finding and two thoracolumbar findings. The alternatives are connected by OR, not requirements that all must be present.
Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine
30% · General spine formula, 30 percent
This row describes cervical spine findings only. It is shown to preserve the complete shared formula; it is not a thoracolumbar 30-percent motion tier.
Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine
20% · General spine formula, 20 percent
The published OR branches include thoracolumbar and cervical measurements, combined motion, and a spasm/guarding branch with specified effects. One angle is not the full formula.
Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis
10% · General spine formula, 10 percent
The published OR branches include measurements, spasm/guarding/tenderness, and a vertebral-fracture branch. Read the exact bounds and exceptions.
Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height
60% · IVDS episode formula, 60 percent
The duration is total qualifying incapacitating-episode time during the past 12 months. The definition requires physician-prescribed bed rest AND physician treatment; ordinary rest days are not interchangeable.
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months
40% · IVDS episode formula, 40 percent
The duration is total qualifying incapacitating-episode time during the past 12 months. The definition requires physician-prescribed bed rest AND physician treatment; ordinary rest days are not interchangeable.
With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months
20% · IVDS episode formula, 20 percent
The duration is total qualifying incapacitating-episode time during the past 12 months. The definition requires physician-prescribed bed rest AND physician treatment; ordinary rest days are not interchangeable.
With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months
10% · IVDS episode formula, 10 percent
The duration is total qualifying incapacitating-episode time during the past 12 months. The definition requires physician-prescribed bed rest AND physician treatment; ordinary rest days are not interchangeable.
With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months