M43.5X6 — Other recurrent vertebral dislocation, lumbar region
M43.5X6 is a billable, specific ICD-10-CM code for other recurrent vertebral dislocation, lumbar region. It is valid for submission on a claim.
Excludes1 inherited from the categories above M43.5X6
These are not written on M43.5X6, but they bind it: a note on a category applies to every code beneath it. Billing M43.5X6 with anything listed here is a denial.
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
M43.5X6 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.
Medicare coverage
M43.5X6 is named in 11 Medicare coverage policies — 4 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
Code history
M43.5X6 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share M43.5X. If M43.5X6 is not quite right, the correct code is usually one of these.
- M43.5X2Other recurrent vertebral dislocation, cervical region
- M43.5X3Other recurrent vertebral dislocation, cervicothoracic region
- M43.5X4Other recurrent vertebral dislocation, thoracic region
- M43.5X5Other recurrent vertebral dislocation, thoracolumbar region
- M43.5X7Other recurrent vertebral dislocation, lumbosacral region
- M43.5X8Other recurrent vertebral dislocation, sacral and sacrococcygeal region
- M43.5X9Other recurrent vertebral dislocation, site unspecified
Questions about M43.5X6
- Is M43.5X6 a billable ICD-10-CM code?
- Yes. M43.5X6 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M43.5X6 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 M43.5X6?
- M43.5X6 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M43.5X6 (M43.5, M43) and apply to it just the same.