M96.0 — Pseudarthrosis after fusion or arthrodesis
M96.0 is a billable, specific ICD-10-CM code for pseudarthrosis after fusion or arthrodesis. It is valid for submission on a claim.
Risk adjustment
M96.0 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
M96.0 is named in 16 Medicare coverage policies — 10 listing it as supporting medical necessity, and 6 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
- 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
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
How M96.0 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to M96.0.
- Nonunion›joint, following fusion or arthrodesis
- Pseudarthrosis, pseudoarthrosis›joint, following fusion or arthrodesis
- Complication›musculoskeletal system›postoperative›pseudarthrosis
- Complication›orthopedic›postprocedural›pseudarthrosis post-fusion
Related codes at this level
Codes that share M96. If M96.0 is not quite right, the correct code is usually one of these.
- M96.1Postlaminectomy syndrome, not elsewhere classified
- M96.2Postradiation kyphosis
- M96.3Postlaminectomy kyphosis
- M96.4Postsurgical lordosis
- M96.5Postradiation scoliosis
- M96.6Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate
- M96.8Other intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified
- M96.AFracture of ribs, sternum and thorax associated with compression of the chest and cardiopulmonary resuscitation
Questions about M96.0
- Is M96.0 a billable ICD-10-CM code?
- Yes. M96.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M96.0 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified (M96).