ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM43.00

M43.00

Billable

Spondylolysis, site unspecified

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

Code Description

ICD-10 M43.00 is a billable code used to indicate a diagnosis of spondylolysis, site unspecified.

Key Diagnostic Point:

Spondylolysis is a defect or fracture in the pars interarticularis of the vertebra, often occurring in the lumbar region. This condition can lead to instability of the spine and may contribute to other spinal deformities such as scoliosis, kyphosis, or lordosis. Patients may present with lower back pain, which can be exacerbated by physical activity or certain movements. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to confirm the presence of the defect. Treatment options vary based on the severity of the condition and may include conservative management with physical therapy and pain management, or surgical interventions such as spinal fusion to stabilize the affected vertebrae. The site of the spondylolysis is often specified in clinical documentation, but when unspecified, it is coded as M43.00. Understanding the implications of spondylolysis is crucial for managing associated spinal deformities and planning appropriate interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for precise imaging documentation
  • Potential for co-existing spinal deformities
  • Differentiation from other spinal conditions

Audit Risk Factors

  • Inadequate documentation of the site of spondylolysis
  • Failure to document associated spinal deformities
  • Lack of imaging reports in the medical record
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed imaging reports, surgical notes, and pre-operative assessments are essential.

Common Clinical Scenarios

Patients presenting with chronic lower back pain, athletes with stress fractures, and individuals with progressive spinal deformities.

Billing Considerations

Ensure clear documentation of the specific vertebra involved and any associated procedures performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes are necessary.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery or those receiving conservative management for spondylolysis.

Billing Considerations

Document functional limitations and response to therapy to support coding for rehabilitation services.

Coding Guidelines

Inclusion Criteria

Use M43.00 When
  • According to ICD
  • 10 coding guidelines, M43
  • 00 should be used when the specific site of spondylolysis is not documented
  • Coders should ensure that all relevant clinical information is captured to support the diagnosis and any associated procedures

Exclusion Criteria

Do NOT use M43.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Lumbar spinal fusion

Clinical Scenario

Used when surgical intervention is required for spondylolysis.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery and any pre-existing conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding spinal conditions, including spondylolysis. This has improved the accuracy of data collection and reimbursement processes, but it also requires coders to be more diligent in documentation and coding practices.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding spinal conditions, including spondylolysis. This has improved the accuracy of data collection and reimbursement processes, but it also requires coders to be more diligent in documentation and coding practices.

Reimbursement & Billing Impact

reimbursement processes, but it also requires coders to be more diligent in documentation and coding practices.

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 difference between spondylolysis and spondylolisthesis?

Spondylolysis refers to a defect in the pars interarticularis of the vertebra, while spondylolisthesis is the slippage of one vertebra over another, which can occur as a result of spondylolysis.