M43
M43 — Other deforming dorsopathies
Non-billable headerICD-10-CM
M43 is a non-billable header ICD-10-CM code for other deforming dorsopathies. It cannot be billed on its own: choose one of the more specific child codes below.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- congenital spondylolysis and spondylolisthesis (Q76.2)
- hemivertebra (Q76.3-Q76.4)
- Klippel-Feil syndrome (Q76.1)
- lumbarization and sacralization (Q76.4)
- platyspondylisis (Q76.4)
- spina bifida occulta (Q76.0)
- spinal curvature in osteoporosis (M80.-)
- spinal curvature in Paget's disease of bone [osteitis deformans] (M88.-)
Other codes that can never be billed with M43
These codes carry an Excludes1 note pointing at M43. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M43 alone.
Risk adjustment
M43 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Code to one of these instead M43
9 child codes. Green means billable.
Questions about M43
- Is M43 a billable ICD-10-CM code?
- No. M43 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does M43 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Deforming dorsopathies (M40-M43).
- What cannot be coded together with M43?
- M43 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.