Budget-friendly ICD-10-CM Rapid Coder charts – code faster in 2019! |Learn More >>
Radiology Coding Alert
Print Friendly and PDF

Reader Question: Use M43 Code Set to Report Congenital Spinal Fusion

- Published on Wed, Jul 11, 2018

Question: I’ve come across a report that states that the L5-S1 spine has fused together. I do not see any reference to a previous fusion surgery. How should I code this diagnosis?

Indiana Subscriber

Answer: As long as the report does not reference a prior arthrodesis procedure, then you may consider the L5-S1 fusion to be congenital. You may then refer to code M43.27 (Fusion of spine, lumbosacral region) as the only code necessary to report the diagnosis.

However, keep in mind that, depending on the reason for the scan, congenital fusion may not be a relevant or vital diagnosis to include. For example, if the patient is experiencing back pain following trauma and the provider detects a herniated disk at the L2-L3 spine, you should not report the congenital fusion as a secondary diagnosis. In fact, you won’t report congenital fusion as a diagnosis at all in this example. However, if there is spinal degeneration or stenosis documented, without an indicating diagnosis of trauma, you may consider including M43.27 as a secondary diagnosis.  

Get 14-Day Fully-Functional Free Trial of Physician Coder

Get access to all your specialty alerts and archived articles along with some comprehensive tools including:
  • Code Search for CPT®, HCPCS, ICD-9 and ICD-10
  • CCI Edits Checker
  • Part B Fees, MUEs
  • CPT-ICD-9 CrossRef
  • CPT® ↔ ICD-9 ↔ ICD-10 CM Crosswalk
  • LCD/NCD Lookup
  • CMS 1500 Claims Scrubber
  • NDC ↔ CPT/HCPCS CrossReference
First Name: *
Last Name: *
User Name: *
E-mail: *
Phone: *
Choose Speciality*
Please enter the characters shown in box*