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v1.0.0
ICD-10 Guide
ICD-10 CodesM43.0

M43.0

Billable

Spondylolysis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M43.0 is a billable code used to indicate a diagnosis of spondylolysis.

Key Diagnostic Point:

Spondylolysis is a defect in the pars interarticularis of the vertebral arch, often resulting from stress fractures due to repetitive trauma or overuse, particularly in athletes. This condition is most commonly seen in the lumbar spine, particularly at the L5 vertebra. Patients may present with lower back pain, which can be exacerbated by physical activity, particularly extension of the lumbar spine. In some cases, spondylolysis can lead to spondylolisthesis, where one vertebra slips forward over another, potentially causing nerve compression and further complications. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to visualize the defect and assess any associated spinal deformities. Treatment options may include conservative management with physical therapy, bracing, and pain management, or surgical intervention such as spinal fusion in cases of significant instability or persistent symptoms. Understanding the implications of spondylolysis is crucial for effective management and coding, particularly in relation to associated spinal deformities like scoliosis, kyphosis, and lordosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms among patients
  • Potential for associated conditions like spondylolisthesis
  • Need for precise imaging documentation
  • Differentiation from other spinal deformities

Audit Risk Factors

  • Inadequate documentation of imaging results
  • Failure to document associated conditions
  • Misclassification of spondylolysis as spondylolisthesis
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes are essential.

Common Clinical Scenarios

Athletes presenting with lower back pain, patients with chronic back pain requiring surgical evaluation.

Billing Considerations

Documentation must clearly differentiate between spondylolysis and other spinal conditions.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, therapy progress notes, and pain management strategies.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery or those with chronic pain management needs.

Billing Considerations

Focus on functional outcomes and the impact of spondylolysis on daily activities.

Coding Guidelines

Inclusion Criteria

Use M43.0 When
  • According to ICD
  • 10 guidelines, M43
  • 0 should be used when there is a confirmed diagnosis of spondylolysis
  • It is important to document the specific vertebra involved and any associated conditions

Exclusion Criteria

Do NOT use M43.0 When
  • Exclusion criteria include conditions that do not involve a defect in the pars interarticularis

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, lumbar

Clinical Scenario

Used when surgical intervention is required for spondylolysis with instability.

Documentation Requirements

Operative reports detailing the procedure and indication for surgery.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spondylolysis, improving the ability to capture the nuances of this condition and its management. This specificity aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylolysis, improving the ability to capture the nuances of this condition and its management. This specificity aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement and compliance.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the primary cause of spondylolysis?

Spondylolysis is primarily caused by repetitive stress and trauma to the lumbar spine, often seen in athletes involved in sports that require hyperextension of the back.