M43.04

M43.04: Spondylolysis, thoracic region

Billable / specific codeICD-10-CM

M43.04 is a billable, specific ICD-10-CM code for spondylolysis, thoracic region. It is valid for submission on a claim.

Check M43.04 with the rest of the claim: free scrubber

Excludes1 inherited from the categories above M43.04

A category’s note binds every code beneath it.

Written on M43.0: Spondylolysis

congenital spondylolysis (Q76.2)
spondylolisthesis (M43.1)

Written on M43: Other deforming dorsopathies

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.-)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

M43.04 is named in 16 Medicare coverage policies: 9 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered

M43.04: Spondylolysis, thoracic region

Excludes1 inherited from the categories above M43.04

Risk adjustment

Medicare coverage

Alphabetic index entries that lead here

Code history

Other codes under M43.0