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ICD-10 Guide
ICD-10 CodesM43.22

M43.22

Billable

Fusion of spine, cervical region

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

Code Description

ICD-10 M43.22 is a billable code used to indicate a diagnosis of fusion of spine, cervical region.

Key Diagnostic Point:

Cervical spine fusion is a surgical procedure aimed at joining two or more vertebrae in the cervical region of the spine to stabilize the spine, alleviate pain, and correct deformities. This procedure is often indicated for conditions such as cervical spondylosis, herniated discs, spinal stenosis, and deformities like scoliosis, kyphosis, or lordosis. The fusion process involves the use of bone grafts, which may be harvested from the patient or obtained from a donor, and the application of hardware such as plates, screws, or rods to maintain alignment during the healing process. The goal is to promote bone growth between the vertebrae, effectively creating a single, solid bone structure. Post-operative care is crucial for recovery, and patients may require physical therapy to regain strength and mobility. Complications can include infection, nerve damage, and non-union of the vertebrae, which may necessitate further intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in surgical techniques and approaches (anterior vs. posterior fusion)
  • Need for precise documentation of the specific vertebrae involved
  • Potential for multiple diagnoses related to spinal deformities
  • Variations in patient anatomy and comorbidities affecting the procedure

Audit Risk Factors

  • Inadequate documentation of the surgical procedure performed
  • Failure to specify the exact vertebrae fused
  • Lack of pre-operative and post-operative notes
  • Inconsistent coding of associated conditions

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients with degenerative disc disease, trauma, or congenital deformities requiring stabilization.

Billing Considerations

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

Neurosurgery

Documentation Requirements

Comprehensive neurological assessments, imaging results, and detailed operative notes.

Common Clinical Scenarios

Patients with herniated discs or spinal stenosis requiring decompression and fusion.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use M43.22 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the procedure, including the specific vertebrae involved and any associated conditions

Exclusion Criteria

Do NOT use M43.22 When
  • Exclude codes for conditions that do not directly relate to the fusion procedure

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Anterior cervical discectomy and fusion

Clinical Scenario

Used when performing fusion for herniated discs.

Documentation Requirements

Operative report detailing the discectomy and fusion process.

Specialty Considerations

Orthopedic or neurosurgical documentation must support the necessity 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 spinal procedures, enhancing the ability to capture the complexity of cervical spine surgeries and improving data accuracy for research and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spinal procedures, enhancing the ability to capture the complexity of cervical spine surgeries and improving data accuracy for research and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 cervical spine fusion?

Cervical spine fusion is primarily indicated for conditions causing instability, such as degenerative disc disease, herniated discs, and spinal deformities like scoliosis or kyphosis.