ICD Code M48.46XS

ICD code M4846XS is used to classify a medical condition where there is a fatigue fracture of a vertebra in the lumbar region, and it is specifically indicating the sequela of that fracture. In this context, "fatigue fracture" refers to a type of stress fracture that occurs due to repetitive stress or strain on the bone, rather than a sudden injury. The lumbar region pertains to the lower part of the spine. The term "sequela" denotes that this code is used for conditions that are the late effects or complications resulting from the original fracture. This could include chronic pain, deformity, or other long-term issues that arise after the initial fracture has healed.

When to use the ICD code M4846XS, related to a fatigue fracture of the lumbar vertebra, sequela of fracture:

1. History of Fracture: Patient has a documented history of a previous vertebral fracture.

2. Lumbar Region Symptoms: Patient presents with localized pain in the lumbar region, particularly after physical activity or stress.

3. Fatigue Fracture Diagnosis: Clinical evaluation indicates a fatigue fracture, often identified through imaging studies such as X-rays or MRI.

4. Sequelae Manifestation: Patient exhibits ongoing symptoms or complications resulting from the initial fracture, such as chronic pain or reduced mobility.

5. Duration of Symptoms: Symptoms have persisted beyond the expected healing time for a typical vertebral fracture.

6. Exclusion of Other Conditions: Other potential causes of lumbar pain have been ruled out through differential diagnosis.

7. Functional Impairment: Patient experiences limitations in daily activities or functional mobility due to the sequela of the fracture.

These criteria should be carefully assessed to ensure accurate coding and appropriate documentation in the patient's medical record.

For the ICD code M48.46XS, which pertains to a fatigue fracture of the vertebra in the lumbar region as a sequela of fracture, the relevant CPT codes that may be applicable for treatment include:

1. 22510 - Percutaneous vertebroplasty (bone cement injection) for the lumbar region.

2. 22511 - Percutaneous vertebroplasty, including cavity creation (e.g., balloon kyphoplasty) for the lumbar region.

3. 22512 - Additional percutaneous vertebroplasty, including cavity creation, for each additional vertebral body.

4. 22899 - Unlisted procedure, spine (used when a specific procedure does not have a designated CPT code).

5. 20930 - Allograft, morselized, or placement of osteopromotive material, for spine surgery.

6. 20931 - Allograft, structural, for spine surgery.

7. 77012 - CT guidance for needle placement (e.g., biopsy, aspiration, injection, or placement), used in conjunction with vertebroplasty or kyphoplasty.

These CPT codes are examples of procedures that may be performed to address the sequelae of a lumbar vertebral fatigue fracture. It's important to consult with a healthcare professional or coding specialist to determine the most appropriate codes based on the specific treatment plan and clinical scenario.

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments for CPT codes associated with ICD code M4846XS. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.