M48.56XS
M48.56XS: Collapsed vertebra, not elsewhere classified, lumbar region, sequela of fracture
Billable / specific codeICD-10-CM
M48.56XS is a billable, specific ICD-10-CM code for collapsed vertebra, not elsewhere classified, lumbar region, sequela of fracture. It is valid for submission on a claim.
Check M48.56XS with the rest of the claim: free scrubber7th character "S": sequela of fracture
The appropriate 7th character is to be added to each code from subcategory M48.5:
- 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 M48.56XS
A category’s note binds every code beneath it.
Written on M48.5: Collapsed vertebra, not elsewhere classified
- current injury - see Injury of spine, by body region
- fatigue fracture of vertebra (M48.4)
- 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.-)
- pathological fracture NOS (M84.4-)
- stress fracture of vertebra (M48.4-)
- traumatic fracture of vertebra (S12.-, S22.-, S32.-)
Other codes that can never be billed with M48.56XS
Their own Excludes1 notes name this code, so the conflict is not listed above.
- G55Nerve root and plexus compressions in diseases classified elsewhere
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
M48.56XS is named in 14 Medicare coverage policies: 7 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
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under M48.56
- M48.56XACollapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture
- M48.56XDCollapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for fracture with routine healing
- M48.56XGCollapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for fracture with delayed healing