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ICD-10 Guide
ICD-10 CodesM43.02

M43.02

Billable

Spondylolysis, cervical region

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

Code Description

ICD-10 M43.02 is a billable code used to indicate a diagnosis of spondylolysis, cervical region.

Key Diagnostic Point:

Spondylolysis in the cervical region refers to a defect or fracture in the pars interarticularis of the cervical vertebrae, which can lead to instability and pain. This condition is often asymptomatic but may present with neck pain, stiffness, and neurological symptoms if there is nerve root involvement. The cervical spine is particularly vulnerable due to its range of motion and the stresses placed upon it during activities such as sports or heavy lifting. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to visualize the defect and assess any associated spinal deformities. Treatment may include conservative management with physical therapy, pain management, and in some cases, surgical intervention such as spinal fusion to stabilize the affected vertebrae. Understanding the implications of spondylolysis is crucial, especially in the context of other spinal deformities like scoliosis, kyphosis, and lordosis, which may complicate the clinical picture and treatment approach.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to document imaging results
  • Misclassification of the condition as a more severe spinal deformity
  • Lack of clarity on treatment plans

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Surgical intervention for symptomatic spondylolysis, particularly in athletes.

Billing Considerations

Documentation must clearly outline the rationale for surgery versus conservative management.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes.

Common Clinical Scenarios

Management of chronic pain and rehabilitation post-surgery.

Billing Considerations

Focus on functional outcomes and patient progress in therapy.

Coding Guidelines

Inclusion Criteria

Use M43.02 When
  • According to ICD
  • 10 guidelines, M43
  • 02 should be used when spondylolysis is specifically diagnosed in the cervical region
  • Coders must ensure that the diagnosis is supported by imaging and clinical findings

Exclusion Criteria

Do NOT use M43.02 When
  • Exclusion criteria include conditions that do not involve the cervical spine

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, cervical

Clinical Scenario

Performed when conservative treatment fails and instability is present.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention.

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 data collection and reimbursement processes. This specificity helps in tracking outcomes and resource utilization in patients with cervical spine issues.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylolysis, improving the accuracy of data collection and reimbursement processes. This specificity helps in tracking outcomes and resource utilization in patients with cervical spine issues.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in tracking outcomes and resource utilization in patients with cervical spine issues.

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 in the cervical region?

Spondylolysis in the cervical region is often caused by repetitive stress or trauma, particularly in athletes involved in contact sports or activities that place significant strain on the neck.