Is M96.4 a billable ICD-10-CM code?

Yes. M96.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does M96.4 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).

M96.4

M96.4 — Postsurgical lordosis

Billable / specific codeICD-10-CM

M96.4 is a billable, specific ICD-10-CM code for postsurgical lordosis. It is valid for submission on a claim.

Excludes2 inherited from the categories above M96.4

Also inherited, and the opposite of Excludes1: these conditions are not part of M96.4, but a patient can have both, so you may code both.

Written on M96 — Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified

arthropathy following intestinal bypass (M02.0-)
complications of internal orthopedic prosthetic devices, implants and grafts (T84.-)
disorders associated with osteoporosis (M80)
periprosthetic fracture around internal prosthetic joint (M97.-)
presence of functional implants and other devices (Z96-Z97)

Other codes that can never be billed with M96.4

These codes carry an Excludes1 note pointing at M96.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M96.4 alone.

M40Kyphosis and lordosis

Risk adjustment

M96.4 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

M96.4 is named in 17 Medicare coverage policies — 10 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

How M96.4 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 M96.4.

Lordosis›postsurgical
Complication›musculoskeletal system›postoperative›lordosis
Complication›orthopedic›postprocedural›postlaminectomy syndrome NEC›lordosis

Code history

M96.4 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 M96. If M96.4 is not quite right, the correct code is usually one of these.

Questions about M96.4

Is M96.4 a billable ICD-10-CM code?: Yes. M96.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does M96.4 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).