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ICD-10 Guide
ICD-10 CodesM43.09

M43.09

Billable

Spondylolysis, multiple sites in spine

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

Code Description

ICD-10 M43.09 is a billable code used to indicate a diagnosis of spondylolysis, multiple sites in spine.

Key Diagnostic Point:

Spondylolysis is a defect or fracture in the pars interarticularis of the vertebra, often leading to instability and potential displacement of the vertebrae. When it occurs at multiple sites in the spine, it can significantly impact spinal alignment and function. This condition is commonly associated with various spinal deformities, including scoliosis, kyphosis, and lordosis, which can exacerbate the symptoms and complicate treatment. Patients may present with lower back pain, muscle spasms, and neurological symptoms if nerve roots are affected. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to confirm the presence of spondylolysis and assess the degree of spinal deformity. Treatment options may include conservative management with physical therapy and pain management, or surgical interventions such as spinal fusion to stabilize the affected vertebrae. The complexity of managing spondylolysis at multiple sites necessitates a comprehensive approach to care, including monitoring for associated conditions and potential complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Multiple sites of involvement complicate diagnosis and treatment.
  • Differentiating from other spinal conditions requires detailed imaging.
  • Potential for associated deformities like scoliosis or kyphosis.
  • Variability in treatment approaches based on severity and symptoms.

Audit Risk Factors

  • Inadequate documentation of multiple sites affected.
  • Failure to document associated spinal deformities.
  • Misinterpretation of imaging results.
  • Lack of clarity in treatment plans and outcomes.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed imaging reports, surgical notes, and follow-up assessments.

Common Clinical Scenarios

Patients presenting with chronic back pain and imaging-confirmed spondylolysis.

Billing Considerations

Ensure documentation reflects the complexity of multiple sites and any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery or conservative management for spondylolysis.

Billing Considerations

Document functional limitations and response to therapy to support coding.

Coding Guidelines

Inclusion Criteria

Use M43.09 When
  • According to ICD
  • 10 guidelines, M43
  • 09 should be used when spondylolysis is confirmed at multiple sites
  • Coders must ensure that the documentation supports the diagnosis and reflects the complexity of the condition

Exclusion Criteria

Do NOT use M43.09 When
  • Exclusion criteria include conditions that do not involve the pars interarticularis

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, posterior technique

Clinical Scenario

Used in surgical treatment of spondylolysis with instability.

Documentation Requirements

Operative report detailing the procedure and indication for surgery.

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 conditions like spondylolysis, enabling better tracking of patient outcomes and treatment efficacy. The granularity of ICD-10 codes helps in understanding the complexities of spinal conditions and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like spondylolysis, enabling better tracking of patient outcomes and treatment efficacy. The granularity of ICD-10 codes helps in understanding the complexities of spinal conditions and their management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like spondylolysis, enabling better tracking of patient outcomes and treatment efficacy. The granularity of ICD-10 codes helps in understanding the complexities of spinal conditions and their management.

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 spondylolysis and spondylolisthesis?

Spondylolysis refers to a defect in the pars interarticularis of the vertebra, while spondylolisthesis involves the slippage of one vertebra over another, which can occur as a result of spondylolysis.