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ICD-10 Guide
ICD-10 CodesM43.11

M43.11

Billable

Spondylolisthesis, occipito-atlanto-axial region

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

Code Description

ICD-10 M43.11 is a billable code used to indicate a diagnosis of spondylolisthesis, occipito-atlanto-axial region.

Key Diagnostic Point:

Spondylolisthesis is a condition characterized by the displacement of one vertebra over another, specifically in the occipito-atlanto-axial region, which includes the base of the skull and the first two cervical vertebrae (C1 and C2). This condition can lead to instability in the cervical spine, resulting in pain, neurological deficits, and impaired function. The occipito-atlanto-axial region is critical for head and neck movement, and any displacement can significantly affect a patient's quality of life. Spondylolisthesis may arise from congenital defects, degenerative changes, trauma, or pathological conditions. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs 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 such as spinal fusion, which aims to stabilize the affected vertebrae and restore normal alignment. Understanding the complexities of this condition is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Need for precise imaging documentation to support diagnosis
  • Differentiation from other spinal conditions such as scoliosis or kyphosis
  • Potential for co-existing conditions that may complicate coding

Audit Risk Factors

  • Inadequate documentation of imaging studies
  • Failure to specify the degree of spondylolisthesis
  • Lack of clarity on the treatment plan and its rationale
  • Misidentification of the affected vertebrae

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and pre-operative assessments are essential for accurate coding.

Common Clinical Scenarios

Patients presenting with neck pain, neurological symptoms, or instability requiring surgical intervention.

Billing Considerations

Documentation must clearly indicate the level of spondylolisthesis and any associated procedures performed.

Neurology

Documentation Requirements

Comprehensive neurological evaluations and imaging results to support diagnosis and treatment decisions.

Common Clinical Scenarios

Patients with neurological deficits due to spinal instability or compression.

Billing Considerations

Neurological assessments must be documented to justify the diagnosis and any interventions.

Coding Guidelines

Inclusion Criteria

Use M43.11 When
  • According to ICD
  • 10 coding guidelines, M43
  • 11 should be used when there is clear documentation of spondylolisthesis in the occipito
  • atlanto
  • axial region
  • Coders must ensure that the diagnosis is supported by imaging and clinical findings

Exclusion Criteria

Do NOT use M43.11 When
  • Exclusion criteria include conditions that do not involve displacement of the vertebrae

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Spinal fusion, occipito-atlanto-axial region

Clinical Scenario

Used in surgical treatment of spondylolisthesis to stabilize the spine.

Documentation Requirements

Operative reports must detail the procedure and rationale for fusion.

Specialty Considerations

Orthopedic surgeons must document the specific vertebrae involved and the extent of the procedure.

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. M43.11 provides a clear distinction for the occipito-atlanto-axial region, which was less defined in ICD-9.

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. M43.11 provides a clear distinction for the occipito-atlanto-axial region, which was less defined in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. M43.11 provides a clear distinction for the occipito-atlanto-axial region, which was less defined in ICD-9.

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 imaging studies are required to support the diagnosis of M43.11?

Imaging studies such as X-rays, CT scans, or MRIs are essential to demonstrate the degree of vertebral displacement and any associated spinal deformities.