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ICD-10 Guide
ICD-10 CodesM43.03

M43.03

Billable

Spondylolysis, cervicothoracic region

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

Code Description

ICD-10 M43.03 is a billable code used to indicate a diagnosis of spondylolysis, cervicothoracic region.

Key Diagnostic Point:

Spondylolysis is a defect or fracture in the pars interarticularis of the vertebra, commonly affecting the lumbar region but can also occur in the cervicothoracic 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 neck pain, stiffness, and neurological symptoms if nerve roots are affected. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to visualize the defect. Treatment options may include conservative management with physical therapy and pain management, or surgical interventions such as spinal fusion to stabilize the affected vertebrae. The cervicothoracic region is particularly significant due to its role in supporting the head and facilitating movement, making any instability potentially impactful on overall function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of imaging results
  • Failure to document conservative treatment attempts
  • Misclassification of the condition's severity
  • Inconsistent use of terminology in clinical notes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with chronic neck pain and imaging confirming spondylolysis.

Billing Considerations

Ensure clarity in surgical indications and outcomes to support coding for procedures.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery or conservative management.

Billing Considerations

Document functional limitations and response to therapy for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M43.03 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include details on the location and severity of the spondylolysis, and document any associated conditions

Exclusion Criteria

Do NOT use M43.03 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, cervical

Clinical Scenario

Used when surgical intervention is required for spondylolysis.

Documentation Requirements

Pre-operative assessments, surgical notes, and post-operative follow-up.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery clearly.

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 accuracy of patient records and facilitating better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylolysis, improving the accuracy of patient records and facilitating better treatment planning.

Reimbursement & Billing Impact

reimbursement.

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 often caused by repetitive stress or trauma to the spine, leading to a defect in the pars interarticularis. It can also be congenital or due to degenerative changes.