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

Their own Excludes1 notes name this code, so the conflict is not listed above.

G55Nerve root and plexus compressions in diseases classified elsewhere
M48.5Collapsed vertebra, not elsewhere classified

Risk adjustment

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

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead M48.4

9 child codes. Green means billable.