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ICD-10 Guide
ICD-10 CodesM48.55

M48.55

Billable

Collapsed vertebra, not elsewhere classified, thoracolumbar region

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

Code Description

ICD-10 M48.55 is a billable code used to indicate a diagnosis of collapsed vertebra, not elsewhere classified, thoracolumbar region.

Key Diagnostic Point:

Collapsed vertebrae in the thoracolumbar region can occur due to various underlying conditions, including trauma, osteoporosis, or malignancy. This code is used when the vertebral collapse is not classified under other specific categories. The thoracolumbar region, which includes the lower thoracic and upper lumbar vertebrae, is particularly susceptible to collapse due to its biomechanical stress and weight-bearing function. Conditions such as spondylopathies, including ankylosing spondylitis, can lead to vertebral collapse due to chronic inflammation and subsequent structural changes. Spinal stenosis, which narrows the spinal canal, may also contribute to vertebral instability and collapse. Inflammatory spine conditions can exacerbate these issues, leading to pain, reduced mobility, and neurological deficits. Accurate diagnosis and coding are essential for appropriate management and treatment planning, as well as for understanding the underlying causes of the vertebral collapse.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various causes of vertebral collapse.
  • Understanding the relationship between underlying conditions like ankylosing spondylitis and vertebral collapse.
  • Identifying the thoracolumbar region accurately in imaging studies.
  • Documenting the clinical significance of the collapse in relation to patient symptoms.

Audit Risk Factors

  • Inadequate documentation of the cause of vertebral collapse.
  • Failure to specify the thoracolumbar region in clinical notes.
  • Misclassification of vertebral collapse due to lack of clarity in imaging reports.
  • Inconsistent coding practices among different specialties.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, clinical notes on the patient's history, and physical examination findings.

Common Clinical Scenarios

Patients presenting with back pain, history of trauma, or chronic inflammatory conditions.

Billing Considerations

Ensure that the documentation clearly states the cause of the collapse and its impact on function.

Rheumatology

Documentation Requirements

Comprehensive assessment of inflammatory markers, imaging studies, and patient-reported outcomes.

Common Clinical Scenarios

Patients with known inflammatory spine diseases presenting with new or worsening back pain.

Billing Considerations

Document the relationship between inflammatory conditions and vertebral collapse to support coding.

Coding Guidelines

Inclusion Criteria

Use M48.55 When
  • According to ICD
  • 10 coding guidelines, M48
  • 55 should be used when the vertebral collapse is not classified elsewhere
  • Coders must ensure that the documentation supports the diagnosis and that the thoracolumbar region is specified
  • It is essential to review the patient's history and any imaging studies to confirm the diagnosis

Exclusion Criteria

Do NOT use M48.55 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Percutaneous vertebroplasty

Clinical Scenario

Used for treating vertebral compression fractures.

Documentation Requirements

Pre-procedure imaging and clinical justification for the procedure.

Specialty Considerations

Orthopedic and interventional radiology specialties may perform this procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like vertebral collapse, improving the granularity of data for research and treatment outcomes. M48.55 provides a distinct code for thoracolumbar vertebral collapse, which was less clearly defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like vertebral collapse, improving the granularity of data for research and treatment outcomes. M48.55 provides a distinct code for thoracolumbar vertebral collapse, which was less clearly defined in ICD-9.

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 cause of a collapsed vertebra?

The primary causes of a collapsed vertebra include osteoporosis, trauma, malignancy, and inflammatory conditions such as ankylosing spondylitis. Each cause may require different management strategies.