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ICD-10 Guide
ICD-10 CodesM43.08

M43.08

Billable

Spondylolysis, sacral and sacrococcygeal region

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

Code Description

ICD-10 M43.08 is a billable code used to indicate a diagnosis of spondylolysis, sacral and sacrococcygeal region.

Key Diagnostic Point:

Spondylolysis is a defect or fracture in the pars interarticularis of the vertebra, which can lead to instability and pain in the lower back. When this condition occurs in the sacral and sacrococcygeal region, it can result in significant discomfort and functional impairment. The sacral region consists of five fused vertebrae, while the coccygeal region comprises the tailbone. Spondylolysis in these areas may be associated with other spinal deformities such as scoliosis, kyphosis, and lordosis, which can complicate the clinical picture. Patients may present with symptoms such as lower back pain, radiating pain to the legs, and reduced mobility. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to confirm the presence of a defect. Treatment options may include conservative management with physical therapy, pain management, and in some cases, surgical intervention such as spinal fusion to stabilize the affected vertebrae and alleviate symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of imaging results
  • Failure to specify the exact location of spondylolysis
  • Misclassification of spondylolysis as a more general back pain code
  • Lack of clarity on associated spinal deformities

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with lower back pain and imaging-confirmed spondylolysis requiring surgical intervention.

Billing Considerations

Ensure that all surgical procedures are documented, including any spinal fusion techniques used.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes.

Common Clinical Scenarios

Patients undergoing conservative management for spondylolysis with physical therapy.

Billing Considerations

Document functional limitations and response to therapy to support coding.

Coding Guidelines

Inclusion Criteria

Use M43.08 When
  • According to ICD
  • 10 coding guidelines, M43
  • 08 should be used when spondylolysis is specifically diagnosed in the sacral and sacrococcygeal region
  • Coders must ensure that the diagnosis is supported by appropriate clinical documentation and imaging studies

Exclusion Criteria

Do NOT use M43.08 When
  • Exclusion criteria include conditions that do not involve the sacral region

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, posterior or posterolateral technique

Clinical Scenario

Used when surgical intervention is required for spondylolysis in the sacral region.

Documentation Requirements

Surgical notes detailing the procedure and indications for surgery.

Specialty Considerations

Orthopedic surgeons must document the specific technique used 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 spondylolysis, enabling better tracking of treatment outcomes and resource allocation. The granularity of ICD-10 codes helps in understanding the prevalence and management of this condition in different populations.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylolysis, enabling better tracking of treatment outcomes and resource allocation. The granularity of ICD-10 codes helps in understanding the prevalence and management of this condition in different populations.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of spondylolysis, enabling better tracking of treatment outcomes and resource allocation. The granularity of ICD-10 codes helps in understanding the prevalence and management of this condition in different populations.

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 primarily caused by repetitive stress or trauma to the spine, often seen in athletes or individuals with certain occupational hazards.