M48.57XA: Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture
M48.57XA is a billable, specific ICD-10-CM code for collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture. It is valid for submission on a claim.
Check M48.57XA with the rest of the claim: free scrubber7th character "A": initial encounter for 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 M48.57XA
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 M48.57XA
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
M48.57XA risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 401 Vertebral Fractures without Spinal Cord Injury0.522 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
M48.57XA is named in 13 Medicare coverage policies: 6 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 M48.57
- M48.57XDCollapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for fracture with routine healing
- M48.57XGCollapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for fracture with delayed healing
- M48.57XSCollapsed vertebra, not elsewhere classified, lumbosacral region, sequela of fracture