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ICD-10 Guide
ICD-10 CodesM48.42

M48.42

Billable

Fatigue fracture of vertebra, cervical region

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

Code Description

ICD-10 M48.42 is a billable code used to indicate a diagnosis of fatigue fracture of vertebra, cervical region.

Key Diagnostic Point:

A fatigue fracture of the cervical vertebrae is a type of stress fracture that occurs due to repetitive mechanical stress on the vertebrae, leading to microdamage and eventual fracture. This condition is often seen in individuals who engage in high-impact activities or those with underlying conditions that weaken the bone structure, such as osteoporosis or inflammatory spine diseases like ankylosing spondylitis. Symptoms may include localized pain in the neck, reduced range of motion, and potential neurological deficits if the spinal cord is affected. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to visualize the fracture and assess any associated spinal stenosis or other complications. Management may include conservative treatment with rest, physical therapy, and pain management, or surgical intervention in severe cases. Understanding the underlying causes, such as spondylopathies or inflammatory conditions, is crucial for effective treatment and prevention of recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between fatigue fractures and other types of vertebral fractures.
  • Understanding the relationship with underlying conditions like ankylosing spondylitis.
  • Need for precise documentation of symptoms and imaging findings.
  • Potential for co-morbidities that complicate the clinical picture.

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury.
  • Failure to document co-existing conditions.
  • Misclassification of fracture type.
  • Lack of imaging results in the medical record.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with chronic neck pain and history of repetitive stress activities.

Billing Considerations

Documentation must clearly differentiate between fatigue fractures and other types of fractures.

Rheumatology

Documentation Requirements

Comprehensive history of inflammatory conditions, lab results, and treatment responses.

Common Clinical Scenarios

Patients with ankylosing spondylitis presenting with new neck pain.

Billing Considerations

Need to document the impact of inflammatory conditions on bone health.

Coding Guidelines

Inclusion Criteria

Use M48.42 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type and any associated conditions
  • Include details about the mechanism of injury and any relevant imaging findings

Exclusion Criteria

Do NOT use M48.42 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

72040CPT Code

X-ray cervical spine, 2 or 3 views

Clinical Scenario

Used to evaluate suspected fatigue fractures in the cervical spine.

Documentation Requirements

Include clinical indications for imaging and results.

Specialty Considerations

Orthopedic specialists may require additional imaging for surgical planning.

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 track and manage these conditions. It has also emphasized the need for detailed documentation to support the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to track and manage these conditions. It has also emphasized the need for detailed documentation to support the diagnosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to track and manage these conditions. It has also emphasized the need for detailed documentation to support the diagnosis.

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 cervical spine?

Fatigue fractures in the cervical spine are primarily caused by repetitive mechanical stress, often exacerbated by underlying conditions such as osteoporosis or inflammatory diseases like ankylosing spondylitis.