ICD-10 Coding for Spondylolysis(M43.16, M43.10)
Complete ICD-10-CM coding and documentation guide for Spondylolysis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Spondylolysis
M43.1-Primary Range
Other spondylolysis
This range includes codes for spondylolysis, specifying the anatomical location and laterality.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M43.16 | Spondylolysis, lumbar region | Use when imaging confirms a lumbar pars defect and documentation specifies laterality. |
|
| M43.10 | Spondylolysis, site unspecified | Use when the specific site of spondylolysis is not documented. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for lumbar spondylolysis
Essential facts and insights about Spondylolysis
Primary ICD-10-CM Codes for spondylolysis
Decision Criteria
clinical Criteria
- Imaging shows lumbar pars defect
documentation Criteria
- Laterality is specified
Applicable To
- Lumbar spondylolysis
Excludes
- Spondylolisthesis (M43.3-)
Clinical Validation Requirements
- Imaging confirmation of pars interarticularis defect
- Documentation of unilateral or bilateral involvement
Code-Specific Risks
- Risk of using unspecified site code when lumbar region is documented.
Coding Notes
- Ensure documentation specifies the anatomical site and laterality to avoid unspecified coding.
M43.10 - Spondylolysis, site unspecified
Use when the specific site of spondylolysis is not documented.
Excludes
- Spondylolisthesis (M43.3-)
Clinical Validation Requirements
- Lack of specific site documentation
Coding Notes
Avoid using if specific site information is available.
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.
Spondylolysis, site unspecified
M43.10Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Spondylolysis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M43.16.
Impact
Clinical: Inaccurate clinical records, Regulatory: Potential for audit issues, Financial: Reduced reimbursement
Mitigation Strategy
Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding may lead to reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in clinical data.
Mitigation Strategy
Use M43.16 when lumbar involvement is confirmed.
Impact
High risk of audit if unspecified codes are used when specific site is documented.
Mitigation Strategy
Always document and code the specific site and laterality.
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 Spondylolysis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Spondylolysis
Use these documentation templates to ensure complete and accurate documentation for Spondylolysis. These templates include all required elements for proper coding and billing.
Orthopedic evaluation of spondylolysis
Specialty: OrthopedicsRequired Elements
- Imaging findings
- Physical exam results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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