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ICD-10 Guide
ICD-10 CodesM43.1

M43.1

Billable

Spondylolisthesis

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

Code Description

ICD-10 M43.1 is a billable code used to indicate a diagnosis of spondylolisthesis.

Key Diagnostic Point:

Spondylolisthesis is a spinal condition characterized by the displacement of one vertebra over another, often leading to spinal instability and potential nerve compression. This condition can occur due to various factors, including congenital defects, degenerative changes, trauma, or stress fractures. Patients may present with symptoms such as lower back pain, leg pain, and neurological deficits depending on the severity and location of the slippage. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to assess the degree of slippage and any associated spinal deformities. Treatment options vary from conservative management, including physical therapy and pain management, to surgical interventions like spinal fusion, which aims to stabilize the affected vertebrae. Understanding the underlying causes and the specific type of spondylolisthesis is crucial for effective treatment and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes (congenital, degenerative, traumatic)
  • Potential for co-existing spinal deformities (scoliosis, kyphosis)
  • Variability in treatment approaches (conservative vs. surgical)
  • Need for precise documentation of symptoms and imaging findings

Audit Risk Factors

  • Inadequate documentation of the degree of vertebral slippage
  • Failure to document associated symptoms or neurological deficits
  • Misclassification of the type of spondylolisthesis
  • Lack of imaging reports to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and pre-operative assessments.

Common Clinical Scenarios

Patients undergoing spinal fusion due to degenerative spondylolisthesis.

Billing Considerations

Ensure accurate documentation of the type of spondylolisthesis and any associated spinal deformities.

Neurology

Documentation Requirements

Neurological assessments, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with radiculopathy or myelopathy due to spondylolisthesis.

Billing Considerations

Document neurological deficits clearly to support the diagnosis and any related procedures.

Coding Guidelines

Inclusion Criteria

Use M43.1 When
  • According to the official ICD
  • 10 coding guidelines, M43
  • 1 should be used when there is clear documentation of spondylolisthesis with specific details regarding the type and severity

Exclusion Criteria

Do NOT use M43.1 When
  • Exclusion criteria include conditions that do not involve vertebral displacement

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Lumbar spinal fusion

Clinical Scenario

Used in surgical treatment of spondylolisthesis to stabilize the spine.

Documentation Requirements

Operative report detailing the procedure, indications, and post-operative care.

Specialty Considerations

Orthopedic surgeons must document the type of fusion and any instrumentation used.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spondylolisthesis, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis and treatment.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spondylolisthesis, improving the accuracy of data collection and reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis and treatment.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the need for detailed documentation to support the diagnosis and treatment.

Resources

Clinical References

  • •
    American Academy of Orthopaedic Surgeons

Coding & Billing References

  • •
    American Academy of Orthopaedic Surgeons

Frequently Asked Questions

What is the difference between spondylolisthesis and spondylolysis?

Spondylolisthesis involves the displacement of a vertebra, while spondylolysis refers to a defect in the vertebral arch without displacement. Accurate coding requires understanding these distinctions.