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v1.0.0
ICD-10 Guide
ICD-10 CodesM43.2

M43.2

Billable

Fusion of spine

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

Code Description

ICD-10 M43.2 is a billable code used to indicate a diagnosis of fusion of spine.

Key Diagnostic Point:

Fusion of the spine, also known as spinal fusion, is a surgical procedure used to join two or more vertebrae in the spine, eliminating motion between them. This procedure is often indicated for various spinal deformities, including scoliosis, kyphosis, and lordosis, as well as degenerative disc disease, spinal instability, or trauma. The goal of spinal fusion is to relieve pain, restore stability, and improve function. In cases of scoliosis, where there is an abnormal lateral curvature of the spine, fusion can help correct the deformity and prevent further progression. Kyphosis, characterized by an excessive forward rounding of the back, may also be treated with fusion to restore normal spinal alignment. Lordosis, or excessive inward curvature of the spine, can lead to discomfort and functional limitations, making fusion a potential treatment option. The procedure typically involves the use of bone grafts, which may be harvested from the patient or obtained from a donor, and instrumentation such as rods and screws to stabilize the spine during the healing process. Post-operative care and rehabilitation are crucial for optimal recovery and functional outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in surgical techniques and approaches
  • Different indications for fusion based on spinal deformities
  • Need for precise documentation of pre-existing conditions
  • Potential for multiple levels of fusion affecting coding

Audit Risk Factors

  • Inadequate documentation of the surgical procedure
  • Failure to specify the levels of fusion performed
  • Lack of clarity regarding the underlying condition
  • Inconsistent coding of post-operative complications

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients with severe scoliosis requiring corrective surgery, patients with degenerative disc disease needing stabilization.

Billing Considerations

Ensure accurate documentation of the surgical approach and any complications encountered during the procedure.

Neurosurgery

Documentation Requirements

Comprehensive neurological evaluations, imaging results, and detailed surgical notes.

Common Clinical Scenarios

Patients with spinal tumors or trauma requiring fusion for stabilization.

Billing Considerations

Document neurological status pre- and post-operatively to support the necessity of the procedure.

Coding Guidelines

Inclusion Criteria

Use M43.2 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the procedure, including the specific vertebrae involved and any associated conditions
  • Include any relevant modifiers to indicate multiple procedures or complications

Exclusion Criteria

Do NOT use M43.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22612CPT Code

Lumbar spinal fusion, posterior technique

Clinical Scenario

Used for patients with lumbar instability requiring fusion.

Documentation Requirements

Operative report detailing the procedure, levels fused, and any complications.

Specialty Considerations

Orthopedic surgeons must document the rationale for fusion and any pre-operative imaging.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spinal fusion procedures, improving the granularity of data collection and reimbursement processes. It has also enhanced the ability to track outcomes and complications associated with spinal surgeries.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spinal fusion procedures, improving the granularity of data collection and reimbursement processes. It has also enhanced the ability to track outcomes and complications associated with spinal surgeries.

Reimbursement & Billing Impact

reimbursement processes. It has also enhanced the ability to track outcomes and complications associated with spinal surgeries.

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 indication for spinal fusion?

The primary indication for spinal fusion is to stabilize the spine in cases of deformities such as scoliosis, kyphosis, and lordosis, as well as to alleviate pain and restore function in patients with degenerative disc disease or spinal instability.