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ICD-10 Guide
ICD-10 CodesM43.16

M43.16

Billable

Spondylolisthesis, lumbar region

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

Code Description

ICD-10 M43.16 is a billable code used to indicate a diagnosis of spondylolisthesis, lumbar region.

Key Diagnostic Point:

Spondylolisthesis is a condition characterized by the displacement of one vertebra over another, commonly occurring in the lumbar region of the spine. This condition can result from various factors, including congenital defects, degenerative changes, trauma, or stress fractures. Patients may present with symptoms such as lower back pain, leg pain, and neurological deficits due to nerve root compression. The severity of symptoms often correlates with the degree of slippage, which can be classified into grades based on the percentage of vertebral displacement. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to assess the degree of slippage and any associated spinal deformities. Treatment options range from conservative management, including physical therapy and pain management, to surgical interventions such as spinal fusion, which aims to stabilize the affected vertebrae and alleviate symptoms. Understanding the nuances of spondylolisthesis is crucial for accurate coding and appropriate management of patients.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes (congenital, traumatic, degenerative)
  • Different grades of severity affecting treatment options
  • Potential for associated conditions (e.g., spinal stenosis, scoliosis)
  • Variability in clinical presentation and symptomatology

Audit Risk Factors

  • Inadequate documentation of imaging results
  • Failure to specify the degree of slippage
  • Misclassification of the type of spondylolisthesis
  • Lack of clarity on conservative vs. surgical management

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and preoperative evaluations.

Common Clinical Scenarios

Surgical intervention for severe spondylolisthesis with associated spinal deformities.

Billing Considerations

Ensure accurate grading of spondylolisthesis and documentation of any spinal fusion procedures performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and treatment plans.

Common Clinical Scenarios

Conservative management of spondylolisthesis with physical therapy.

Billing Considerations

Document the patient's response to therapy and any changes in symptoms.

Coding Guidelines

Inclusion Criteria

Use M43.16 When
  • According to ICD
  • 10 guidelines, M43
  • 16 should be used when spondylolisthesis is specifically identified in the lumbar region
  • Coders must ensure that the documentation supports the diagnosis and includes details about the severity and any associated conditions

Exclusion Criteria

Do NOT use M43.16 When
  • Exclusion criteria include conditions that do not involve vertebral displacement

Related ICD-10 Codes

Related CPT Codes

22630CPT Code

Lumbar spinal fusion

Clinical Scenario

Used in cases of severe spondylolisthesis requiring stabilization.

Documentation Requirements

Operative report detailing the procedure and indications for surgery.

Specialty Considerations

Orthopedic surgeons must document the specific levels fused and any complications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spondylolisthesis, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylolisthesis, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of spondylolisthesis, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management and resource allocation.

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 spondylolisthesis and spondylolysis?

Spondylolisthesis involves the forward displacement of a vertebra, while spondylolysis refers to a defect in the vertebra without displacement.