ICD-10 Coding for Lumbar Spondylolysis(M43.06)
Complete ICD-10-CM coding and documentation guide for Lumbar Spondylolysis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbar Spondylolysis
M43.0-M43.1Primary Range
Spondylolysis and Spondylolisthesis
This range includes codes for spondylolysis and spondylolisthesis, which are critical for coding lumbar spine conditions.
Key Information: ICD-10 code for lumbar spondylolysis
Essential facts and insights about Lumbar Spondylolysis
Primary ICD-10-CM Code for lumbar spondylolysis
Decision Criteria
clinical Criteria
- Imaging shows pars defect without slippage.
Applicable To
- Lumbar pars defect
- Lumbar stress fracture
Excludes
- Spondylolisthesis (M43.16)
Clinical Validation Requirements
- CT or MRI confirmation of pars defect
- Absence of vertebral slippage
Code-Specific Risks
- Incorrectly coding as spondylolisthesis without slippage evidence
Coding Notes
- Ensure imaging studies are documented to support the diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Low back pain
M54.5Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Spondylolisthesis, lumbar region
M43.16Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lumbar Spondylolysis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M43.06.
Impact
Clinical: Leads to vague clinical records., Regulatory: Non-compliance with specificity requirements., Financial: Potential for claim denials.
Mitigation Strategy
Use specific codes based on imaging findings., Ensure documentation supports the chosen code.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify imaging for slippage before coding spondylolisthesis.
Impact
Lack of imaging documentation can lead to audit flags.
Mitigation Strategy
Ensure all imaging studies are included in the patient's record.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Lumbar Spondylolysis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbar Spondylolysis
Use these documentation templates to ensure complete and accurate documentation for Lumbar Spondylolysis. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation for Lumbar Spondylolysis
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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