M48.47XA — Fatigue fracture of vertebra, lumbosacral region, initial encounter for fracture
M48.47XA is a billable, specific ICD-10-CM code for fatigue fracture of vertebra, lumbosacral region, initial encounter for fracture. It is valid for submission on a claim.
7th character "A" — initial encounter for fracture
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 inherited from the categories above M48.47XA
These are not written on M48.47XA, but they bind it: a note on a category applies to every code beneath it. Billing M48.47XA with anything listed here is a denial.
Written on M48.4 — Fatigue fracture of vertebra
Other codes that can never be billed with M48.47XA
These codes carry an Excludes1 note pointing at M48.47XA. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M48.47XA alone.
- G55Nerve root and plexus compressions in diseases classified elsewhere
Risk adjustment
M48.47XA 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
M48.47XA is named in 12 Medicare coverage policies — 5 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
M48.47XA 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 M48.47. If M48.47XA is not quite right, the correct code is usually one of these.
- M48.47XDFatigue fracture of vertebra, lumbosacral region, subsequent encounter for fracture with routine healing
- M48.47XGFatigue fracture of vertebra, lumbosacral region, subsequent encounter for fracture with delayed healing
- M48.47XSFatigue fracture of vertebra, lumbosacral region, sequela of fracture
Questions about M48.47XA
- Is M48.47XA a billable ICD-10-CM code?
- Yes. M48.47XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M48.47XA 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 M48.47XA?
- M48.47XA 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 M48.47XA (M48.4) and apply to it just the same.