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ICD-10 Guide
ICD-10 CodesM48.40

M48.40

Billable

Fatigue fracture of vertebra, site unspecified

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

Code Description

ICD-10 M48.40 is a billable code used to indicate a diagnosis of fatigue fracture of vertebra, site unspecified.

Key Diagnostic Point:

Fatigue fractures of the vertebrae, also known as stress fractures, occur due to repetitive mechanical stress that exceeds the bone's ability to repair itself. These fractures are particularly common in individuals with underlying conditions such as spondylopathies, ankylosing spondylitis, and spinal stenosis, which can weaken the vertebrae and predispose them to injury. Inflammatory spine conditions can also contribute to the development of fatigue fractures by altering the normal biomechanics of the spine. Symptoms may include localized pain, tenderness, and reduced mobility, often exacerbated by physical activity. Diagnosis typically involves imaging studies such as X-rays, MRI, or CT scans to confirm the presence of a fracture and rule out other conditions. Treatment may involve rest, physical therapy, and in some cases, surgical intervention. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms among patients
  • Need for comprehensive documentation of underlying conditions
  • Differentiation from other types of vertebral fractures
  • Potential for multiple co-existing spinal conditions

Audit Risk Factors

  • Inadequate documentation of the fracture site
  • Failure to document underlying conditions contributing to the fracture
  • Misclassification of fracture type
  • Inconsistent coding practices among providers

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes are essential.

Common Clinical Scenarios

Patients presenting with back pain and a history of repetitive stress or underlying spinal conditions.

Billing Considerations

Ensure that all relevant imaging and diagnostic tests are documented to support the diagnosis.

Rheumatology

Documentation Requirements

Comprehensive history of inflammatory conditions, treatment response, and any comorbidities.

Common Clinical Scenarios

Patients with ankylosing spondylitis presenting with new onset back pain.

Billing Considerations

Document the relationship between inflammatory conditions and the development of fatigue fractures.

Coding Guidelines

Inclusion Criteria

Use M48.40 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the code is used only when the fracture site is unspecified
  • Document any relevant history of trauma or underlying conditions that may contribute to the fracture

Exclusion Criteria

Do NOT use M48.40 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Percutaneous vertebroplasty

Clinical Scenario

Used in cases of vertebral compression fractures, including fatigue fractures.

Documentation Requirements

Document the indication for the procedure and any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to capture the complexity of these conditions and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to capture the complexity of these conditions and their management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fatigue fractures, improving the ability to capture the complexity of these 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 a fatigue fracture and an acute fracture?

A fatigue fracture develops gradually due to repetitive stress, while an acute fracture occurs suddenly due to trauma or injury.