Is M48.4 a billable ICD-10-CM code?

No. M48.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M48.4 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Spondylopathies (M45-M49).

What cannot be coded together with M48.4?

M48.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

M48.4

M48.4 — Fatigue fracture of vertebra

Non-billable headerICD-10-CM

M48.4 is a non-billable header ICD-10-CM code for fatigue fracture of vertebra. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

The appropriate 7th character is to be added to each code from subcategory M48.4:

A: initial encounter for fracture
D: subsequent encounter for fracture with routine healing
G: subsequent encounter for fracture with delayed healing
S: sequela of fracture

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

pathological fracture NOS (M84.4-)
pathological fracture of vertebra due to neoplasm (M84.58)
pathological fracture of vertebra due to other diagnosis (M84.68)
pathological fracture of vertebra due to osteoporosis (M80.-)
traumatic fracture of vertebrae (S12.0-S12.3-, S22.0-, S32.0-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Stress fracture of vertebra

Other codes that can never be billed with M48.4

These codes carry an Excludes1 note pointing at M48.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M48.4 alone.

M48.5Collapsed vertebra, not elsewhere classified

Risk adjustment

M48.4 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 M48.4

9 child codes. Green means billable.

Related codes at this level

Codes that share M48. If M48.4 is not quite right, the correct code is usually one of these.

Questions about M48.4

Is M48.4 a billable ICD-10-CM code?: No. M48.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M48.4 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Spondylopathies (M45-M49).
What cannot be coded together with M48.4?: M48.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.