ICD-10 Coding for Spinal Fusion(M43.26)
Complete ICD-10-CM coding and documentation guide for Spinal Fusion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Spinal Fusion
M43.2-M43.29Primary Range
Fusion of spine
This range includes codes for different types of spinal fusion procedures, categorized by spinal region.
Key Information: ICD-10 code for lumbar spinal fusion
Essential facts and insights about Spinal Fusion
Primary ICD-10-CM Code for spinal fusion
Decision Criteria
clinical Criteria
- Lumbar region involvement confirmed by imaging
Applicable To
- Lumbar spinal fusion
Excludes
- Cervical spinal fusion (M43.22)
Clinical Validation Requirements
- Documentation of lumbar region involvement
- Imaging reports confirming fusion
Code-Specific Risks
- Incorrect documentation of spinal region
Coding Notes
- Ensure documentation specifies lumbar region and approach.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Anterior lumbar fusion with interbody device
0SG00A0Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Fusion of spine, cervical region
M43.22Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Spinal Fusion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M43.26.
Impact
Clinical: Inaccurate clinical records, Regulatory: Potential audit issues, Financial: Denied claims
Mitigation Strategy
Verify operative notes, Include approach in documentation
Impact
Reimbursement: Incorrect reimbursement due to overcoding, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate data reporting
Mitigation Strategy
Use correct instrumentation code based on the number of segments.
Impact
Missing details on approach and materials used
Mitigation Strategy
Use standardized templates for documentation
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 Spinal Fusion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Spinal Fusion
Use these documentation templates to ensure complete and accurate documentation for Spinal Fusion. These templates include all required elements for proper coding and billing.
Lumbar spinal fusion
Specialty: Orthopedic SurgeryRequired Elements
- Patient history
- Physical exam findings
- Imaging results
- Operative details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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