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ICD-10 Guide
ICD-10 CodesM48.4

M48.4

Billable

Fatigue fracture of vertebra

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

Code Description

ICD-10 M48.4 is a billable code used to indicate a diagnosis of fatigue fracture of vertebra.

Key Diagnostic Point:

Fatigue fractures of the vertebra are stress fractures that occur due to repetitive loading or overuse, often seen in individuals with underlying conditions such as spondylopathies, ankylosing spondylitis, or spinal stenosis. These fractures can result from chronic mechanical stress on the vertebrae, leading to microdamage that accumulates over time. Patients may present with localized back pain, which can be exacerbated by activity and relieved by rest. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to visualize the fracture and assess for any associated conditions. Inflammatory spine conditions can further complicate the clinical picture, as they may lead to altered biomechanics and increased susceptibility to fractures. Management often includes conservative measures such as rest, physical therapy, and pain management, although surgical intervention may be necessary in severe cases. Understanding the interplay between fatigue fractures and other spinal conditions is crucial for accurate diagnosis and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between fatigue fractures and other types of vertebral fractures.
  • Understanding the impact of underlying conditions like ankylosing spondylitis.
  • Interpreting imaging results accurately.
  • Documenting the patient's history of repetitive stress or underlying inflammatory conditions.

Audit Risk Factors

  • Inadequate documentation of the patient's history of repetitive stress.
  • Failure to document co-existing conditions like ankylosing spondylitis.
  • Misinterpretation of imaging studies leading to incorrect coding.
  • Lack of clarity in treatment plans that may affect coding.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of the patient's symptoms, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic back pain and a history of repetitive activities.

Billing Considerations

Ensure that all relevant imaging studies are included in the documentation.

Rheumatology

Documentation Requirements

Comprehensive assessment of inflammatory markers and history of spondyloarthritis.

Common Clinical Scenarios

Patients with ankylosing spondylitis presenting with new onset back pain.

Billing Considerations

Document the relationship between inflammatory conditions and vertebral health.

Coding Guidelines

Inclusion Criteria

Use M48.4 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the patient's history, imaging results, and treatment plans
  • Include any relevant co
  • existing conditions that may impact the diagnosis

Exclusion Criteria

Do NOT use M48.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

72040CPT Code

X-ray of the spine, 2 or 3 views

Clinical Scenario

Used to evaluate suspected fatigue fractures.

Documentation Requirements

Include clinical indications for the X-ray and findings.

Specialty Considerations

Orthopedic specialists should ensure imaging correlates with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to capture the nuances of these conditions and their relationship with underlying diseases.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to capture the nuances of these conditions and their relationship with underlying diseases.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to capture the nuances of these conditions and their relationship with underlying diseases.

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 fatigue fractures in the vertebra?

Fatigue fractures are primarily caused by repetitive stress on the vertebrae, often exacerbated by underlying conditions such as spondylopathies or inflammatory spine diseases.