Local Coverage Article Billing and Coding

Billing and Coding: Lumbar Spinal Fusion

A56396

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General Information

Article ID
A56396
Article Title
Billing and Coding: Lumbar Spinal Fusion
Article Type
Billing and Coding
Original Effective Date
05/06/2019
Revision Effective Date
01/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary information to process that claim

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Lumbar Spinal Fusion L37848.

Coding Information

CPT/HCPCS Codes

Group 1

(5 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
22533 ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR
22558 ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR
22612 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE INTERSPACE; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED)
22630 ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; LUMBAR
22633 ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; LUMBAR

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(308 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
C41.2 Malignant neoplasm of vertebral column
C70.1 Malignant neoplasm of spinal meninges
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
D32.1 Benign neoplasm of spinal meninges
D33.4 Benign neoplasm of spinal cord
D42.1 Neoplasm of uncertain behavior of spinal meninges
D43.4 Neoplasm of uncertain behavior of spinal cord
G06.1 Intraspinal abscess and granuloma
G07 Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere
M40.35 Flatback syndrome, thoracolumbar region
M40.36 Flatback syndrome, lumbar region
M40.37 Flatback syndrome, lumbosacral region
M41.05 Infantile idiopathic scoliosis, thoracolumbar region
M41.06 Infantile idiopathic scoliosis, lumbar region
M41.07 Infantile idiopathic scoliosis, lumbosacral region
M41.115 Juvenile idiopathic scoliosis, thoracolumbar region
M41.116 Juvenile idiopathic scoliosis, lumbar region
M41.117 Juvenile idiopathic scoliosis, lumbosacral region
M41.125 Adolescent idiopathic scoliosis, thoracolumbar region
M41.126 Adolescent idiopathic scoliosis, lumbar region
M41.127 Adolescent idiopathic scoliosis, lumbosacral region
M41.25 Other idiopathic scoliosis, thoracolumbar region
M41.26 Other idiopathic scoliosis, lumbar region
M41.27 Other idiopathic scoliosis, lumbosacral region
M41.35 Thoracogenic scoliosis, thoracolumbar region
M41.45 Neuromuscular scoliosis, thoracolumbar region
M41.46 Neuromuscular scoliosis, lumbar region
M41.47 Neuromuscular scoliosis, lumbosacral region
M41.55 Other secondary scoliosis, thoracolumbar region
M41.56 Other secondary scoliosis, lumbar region
M41.57 Other secondary scoliosis, lumbosacral region
M41.85 Other forms of scoliosis, thoracolumbar region
M41.86 Other forms of scoliosis, lumbar region
M41.87 Other forms of scoliosis, lumbosacral region
M43.05 Spondylolysis, thoracolumbar region
M43.06 Spondylolysis, lumbar region
M43.07 Spondylolysis, lumbosacral region
M43.09 Spondylolysis, multiple sites in spine
M43.15 Spondylolisthesis, thoracolumbar region
M43.16 Spondylolisthesis, lumbar region
M43.17 Spondylolisthesis, lumbosacral region
M43.5X5 Other recurrent vertebral dislocation, thoracolumbar region
M43.5X6 Other recurrent vertebral dislocation, lumbar region
M43.5X7 Other recurrent vertebral dislocation, lumbosacral region
M43.8X5 Other specified deforming dorsopathies, thoracolumbar region
M43.8X6 Other specified deforming dorsopathies, lumbar region
M43.8X7 Other specified deforming dorsopathies, lumbosacral region
M46.25 Osteomyelitis of vertebra, thoracolumbar region
M46.26 Osteomyelitis of vertebra, lumbar region
M46.27 Osteomyelitis of vertebra, lumbosacral region
M46.35 Infection of intervertebral disc (pyogenic), thoracolumbar region
M46.36 Infection of intervertebral disc (pyogenic), lumbar region
M46.37 Infection of intervertebral disc (pyogenic), lumbosacral region
M46.39 Infection of intervertebral disc (pyogenic), multiple sites in spine
M46.45 Discitis, unspecified, thoracolumbar region
M46.46 Discitis, unspecified, lumbar region
M46.47 Discitis, unspecified, lumbosacral region
M46.49 Discitis, unspecified, multiple sites in spine
M46.55 Other infective spondylopathies, thoracolumbar region
M46.56 Other infective spondylopathies, lumbar region
M46.57 Other infective spondylopathies, lumbosacral region
M46.59 Other infective spondylopathies, multiple sites in spine
M47.15 Other spondylosis with myelopathy, thoracolumbar region
M47.16 Other spondylosis with myelopathy, lumbar region
M47.25 Other spondylosis with radiculopathy, thoracolumbar region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M48.35 Traumatic spondylopathy, thoracolumbar region
M48.36 Traumatic spondylopathy, lumbar region
M48.37 Traumatic spondylopathy, lumbosacral region
M48.45XA Fatigue fracture of vertebra, thoracolumbar region, initial encounter for fracture
M48.45XD Fatigue fracture of vertebra, thoracolumbar region, subsequent encounter for fracture with routine healing
M48.45XG Fatigue fracture of vertebra, thoracolumbar region, subsequent encounter for fracture with delayed healing
M48.45XS Fatigue fracture of vertebra, thoracolumbar region, sequela of fracture
M48.46XA Fatigue fracture of vertebra, lumbar region, initial encounter for fracture
M48.46XD Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with routine healing
M48.46XG Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with delayed healing
M48.46XS Fatigue fracture of vertebra, lumbar region, sequela of fracture
M48.47XA Fatigue fracture of vertebra, lumbosacral region, initial encounter for fracture
M48.47XD Fatigue fracture of vertebra, lumbosacral region, subsequent encounter for fracture with routine healing
M48.47XG Fatigue fracture of vertebra, lumbosacral region, subsequent encounter for fracture with delayed healing
M48.47XS Fatigue fracture of vertebra, lumbosacral region, sequela of fracture
M48.55XA Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture
M48.55XD Collapsed vertebra, not elsewhere classified, thoracolumbar region, subsequent encounter for fracture with routine healing
M48.55XG Collapsed vertebra, not elsewhere classified, thoracolumbar region, subsequent encounter for fracture with delayed healing
M48.55XS Collapsed vertebra, not elsewhere classified, thoracolumbar region, sequela of fracture
M48.56XA Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture
M48.56XD Collapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for fracture with routine healing
M48.56XG Collapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for fracture with delayed healing
M48.56XS Collapsed vertebra, not elsewhere classified, lumbar region, sequela of fracture
M48.57XA Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture
M48.57XD Collapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for fracture with routine healing
M48.57XG Collapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for fracture with delayed healing
M48.57XS Collapsed vertebra, not elsewhere classified, lumbosacral region, sequela of fracture
M51.05 Intervertebral disc disorders with myelopathy, thoracolumbar region
M51.06 Intervertebral disc disorders with myelopathy, lumbar region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M53.2X5 Spinal instabilities, thoracolumbar region
M53.2X6 Spinal instabilities, lumbar region
M53.2X7 Spinal instabilities, lumbosacral region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XD Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.08XG Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.08XK Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.08XP Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.08XS Age-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.0AXA Age-related osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.0AXD Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.0AXG Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.0AXK Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.0AXP Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.0AXS Age-related osteoporosis with current pathological fracture, other site, sequela
M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XD Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.88XG Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.88XK Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.88XP Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.88XS Other osteoporosis with current pathological fracture, vertebra(e), sequela
M80.8AXA Other osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.8AXD Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.8AXG Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.8AXK Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.8AXP Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.8AXS Other osteoporosis with current pathological fracture, other site, sequela
M96.0 Pseudarthrosis after fusion or arthrodesis
S32.010A Wedge compression fracture of first lumbar vertebra, initial encounter for closed fracture
S32.010B Wedge compression fracture of first lumbar vertebra, initial encounter for open fracture
S32.010D Wedge compression fracture of first lumbar vertebra, subsequent encounter for fracture with routine healing
S32.010G Wedge compression fracture of first lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.010K Wedge compression fracture of first lumbar vertebra, subsequent encounter for fracture with nonunion
S32.010S Wedge compression fracture of first lumbar vertebra, sequela
S32.011A Stable burst fracture of first lumbar vertebra, initial encounter for closed fracture
S32.011B Stable burst fracture of first lumbar vertebra, initial encounter for open fracture
S32.011D Stable burst fracture of first lumbar vertebra, subsequent encounter for fracture with routine healing
S32.011G Stable burst fracture of first lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.011K Stable burst fracture of first lumbar vertebra, subsequent encounter for fracture with nonunion
S32.011S Stable burst fracture of first lumbar vertebra, sequela
S32.012A Unstable burst fracture of first lumbar vertebra, initial encounter for closed fracture
S32.012B Unstable burst fracture of first lumbar vertebra, initial encounter for open fracture
S32.012D Unstable burst fracture of first lumbar vertebra, subsequent encounter for fracture with routine healing
S32.012G Unstable burst fracture of first lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.012K Unstable burst fracture of first lumbar vertebra, subsequent encounter for fracture with nonunion
S32.012S Unstable burst fracture of first lumbar vertebra, sequela
S32.018A Other fracture of first lumbar vertebra, initial encounter for closed fracture
S32.018B Other fracture of first lumbar vertebra, initial encounter for open fracture
S32.018D Other fracture of first lumbar vertebra, subsequent encounter for fracture with routine healing
S32.018G Other fracture of first lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.018K Other fracture of first lumbar vertebra, subsequent encounter for fracture with nonunion
S32.018S Other fracture of first lumbar vertebra, sequela
S32.019A Unspecified fracture of first lumbar vertebra, initial encounter for closed fracture
S32.019B Unspecified fracture of first lumbar vertebra, initial encounter for open fracture
S32.019D Unspecified fracture of first lumbar vertebra, subsequent encounter for fracture with routine healing
S32.019G Unspecified fracture of first lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.019K Unspecified fracture of first lumbar vertebra, subsequent encounter for fracture with nonunion
S32.019S Unspecified fracture of first lumbar vertebra, sequela
S32.020A Wedge compression fracture of second lumbar vertebra, initial encounter for closed fracture
S32.020B Wedge compression fracture of second lumbar vertebra, initial encounter for open fracture
S32.020D Wedge compression fracture of second lumbar vertebra, subsequent encounter for fracture with routine healing
S32.020G Wedge compression fracture of second lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.020K Wedge compression fracture of second lumbar vertebra, subsequent encounter for fracture with nonunion
S32.020S Wedge compression fracture of second lumbar vertebra, sequela
S32.021A Stable burst fracture of second lumbar vertebra, initial encounter for closed fracture
S32.021B Stable burst fracture of second lumbar vertebra, initial encounter for open fracture
S32.021D Stable burst fracture of second lumbar vertebra, subsequent encounter for fracture with routine healing
S32.021G Stable burst fracture of second lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.021K Stable burst fracture of second lumbar vertebra, subsequent encounter for fracture with nonunion
S32.021S Stable burst fracture of second lumbar vertebra, sequela
S32.022A Unstable burst fracture of second lumbar vertebra, initial encounter for closed fracture
S32.022B Unstable burst fracture of second lumbar vertebra, initial encounter for open fracture
S32.022D Unstable burst fracture of second lumbar vertebra, subsequent encounter for fracture with routine healing
S32.022G Unstable burst fracture of second lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.022K Unstable burst fracture of second lumbar vertebra, subsequent encounter for fracture with nonunion
S32.022S Unstable burst fracture of second lumbar vertebra, sequela
S32.028A Other fracture of second lumbar vertebra, initial encounter for closed fracture
S32.028B Other fracture of second lumbar vertebra, initial encounter for open fracture
S32.028D Other fracture of second lumbar vertebra, subsequent encounter for fracture with routine healing
S32.028G Other fracture of second lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.028K Other fracture of second lumbar vertebra, subsequent encounter for fracture with nonunion
S32.028S Other fracture of second lumbar vertebra, sequela
S32.029A Unspecified fracture of second lumbar vertebra, initial encounter for closed fracture
S32.029B Unspecified fracture of second lumbar vertebra, initial encounter for open fracture
S32.029D Unspecified fracture of second lumbar vertebra, subsequent encounter for fracture with routine healing
S32.029G Unspecified fracture of second lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.029K Unspecified fracture of second lumbar vertebra, subsequent encounter for fracture with nonunion
S32.029S Unspecified fracture of second lumbar vertebra, sequela
S32.030A Wedge compression fracture of third lumbar vertebra, initial encounter for closed fracture
S32.030B Wedge compression fracture of third lumbar vertebra, initial encounter for open fracture
S32.030D Wedge compression fracture of third lumbar vertebra, subsequent encounter for fracture with routine healing
S32.030G Wedge compression fracture of third lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.030K Wedge compression fracture of third lumbar vertebra, subsequent encounter for fracture with nonunion
S32.030S Wedge compression fracture of third lumbar vertebra, sequela
S32.031A Stable burst fracture of third lumbar vertebra, initial encounter for closed fracture
S32.031B Stable burst fracture of third lumbar vertebra, initial encounter for open fracture
S32.031D Stable burst fracture of third lumbar vertebra, subsequent encounter for fracture with routine healing
S32.031G Stable burst fracture of third lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.031K Stable burst fracture of third lumbar vertebra, subsequent encounter for fracture with nonunion
S32.031S Stable burst fracture of third lumbar vertebra, sequela
S32.032A Unstable burst fracture of third lumbar vertebra, initial encounter for closed fracture
S32.032B Unstable burst fracture of third lumbar vertebra, initial encounter for open fracture
S32.032D Unstable burst fracture of third lumbar vertebra, subsequent encounter for fracture with routine healing
S32.032G Unstable burst fracture of third lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.032K Unstable burst fracture of third lumbar vertebra, subsequent encounter for fracture with nonunion
S32.032S Unstable burst fracture of third lumbar vertebra, sequela
S32.038A Other fracture of third lumbar vertebra, initial encounter for closed fracture
S32.038B Other fracture of third lumbar vertebra, initial encounter for open fracture
S32.038D Other fracture of third lumbar vertebra, subsequent encounter for fracture with routine healing
S32.038G Other fracture of third lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.038K Other fracture of third lumbar vertebra, subsequent encounter for fracture with nonunion
S32.038S Other fracture of third lumbar vertebra, sequela
S32.039A Unspecified fracture of third lumbar vertebra, initial encounter for closed fracture
S32.039B Unspecified fracture of third lumbar vertebra, initial encounter for open fracture
S32.039D Unspecified fracture of third lumbar vertebra, subsequent encounter for fracture with routine healing
S32.039G Unspecified fracture of third lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.039K Unspecified fracture of third lumbar vertebra, subsequent encounter for fracture with nonunion
S32.039S Unspecified fracture of third lumbar vertebra, sequela
S32.040A Wedge compression fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.040B Wedge compression fracture of fourth lumbar vertebra, initial encounter for open fracture
S32.040D Wedge compression fracture of fourth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.040G Wedge compression fracture of fourth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.040K Wedge compression fracture of fourth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.040S Wedge compression fracture of fourth lumbar vertebra, sequela
S32.041A Stable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.041B Stable burst fracture of fourth lumbar vertebra, initial encounter for open fracture
S32.041D Stable burst fracture of fourth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.041G Stable burst fracture of fourth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.041K Stable burst fracture of fourth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.041S Stable burst fracture of fourth lumbar vertebra, sequela
S32.042A Unstable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.042B Unstable burst fracture of fourth lumbar vertebra, initial encounter for open fracture
S32.042D Unstable burst fracture of fourth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.042G Unstable burst fracture of fourth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.042K Unstable burst fracture of fourth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.042S Unstable burst fracture of fourth lumbar vertebra, sequela
S32.048A Other fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.048B Other fracture of fourth lumbar vertebra, initial encounter for open fracture
S32.048D Other fracture of fourth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.048G Other fracture of fourth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.048K Other fracture of fourth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.048S Other fracture of fourth lumbar vertebra, sequela
S32.049A Unspecified fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.049B Unspecified fracture of fourth lumbar vertebra, initial encounter for open fracture
S32.049D Unspecified fracture of fourth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.049G Unspecified fracture of fourth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.049K Unspecified fracture of fourth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.049S Unspecified fracture of fourth lumbar vertebra, sequela
S32.050A Wedge compression fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.050B Wedge compression fracture of fifth lumbar vertebra, initial encounter for open fracture
S32.050D Wedge compression fracture of fifth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.050G Wedge compression fracture of fifth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.050K Wedge compression fracture of fifth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.050S Wedge compression fracture of fifth lumbar vertebra, sequela
S32.051A Stable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.051B Stable burst fracture of fifth lumbar vertebra, initial encounter for open fracture
S32.051D Stable burst fracture of fifth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.051G Stable burst fracture of fifth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.051K Stable burst fracture of fifth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.051S Stable burst fracture of fifth lumbar vertebra, sequela
S32.052A Unstable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.052B Unstable burst fracture of fifth lumbar vertebra, initial encounter for open fracture
S32.052D Unstable burst fracture of fifth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.052G Unstable burst fracture of fifth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.052K Unstable burst fracture of fifth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.052S Unstable burst fracture of fifth lumbar vertebra, sequela
S32.058A Other fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.058B Other fracture of fifth lumbar vertebra, initial encounter for open fracture
S32.058D Other fracture of fifth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.058G Other fracture of fifth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.058K Other fracture of fifth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.058S Other fracture of fifth lumbar vertebra, sequela
S32.059A Unspecified fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.059B Unspecified fracture of fifth lumbar vertebra, initial encounter for open fracture
S32.059D Unspecified fracture of fifth lumbar vertebra, subsequent encounter for fracture with routine healing
S32.059G Unspecified fracture of fifth lumbar vertebra, subsequent encounter for fracture with delayed healing
S32.059K Unspecified fracture of fifth lumbar vertebra, subsequent encounter for fracture with nonunion
S32.059S Unspecified fracture of fifth lumbar vertebra, sequela
S33.0XXA Traumatic rupture of lumbar intervertebral disc, initial encounter
S33.0XXD Traumatic rupture of lumbar intervertebral disc, subsequent encounter
S33.0XXS Traumatic rupture of lumbar intervertebral disc, sequela
S33.110A Subluxation of L1/L2 lumbar vertebra, initial encounter
S33.110D Subluxation of L1/L2 lumbar vertebra, subsequent encounter
S33.110S Subluxation of L1/L2 lumbar vertebra, sequela
S33.111A Dislocation of L1/L2 lumbar vertebra, initial encounter
S33.111D Dislocation of L1/L2 lumbar vertebra, subsequent encounter
S33.111S Dislocation of L1/L2 lumbar vertebra, sequela
S33.120A Subluxation of L2/L3 lumbar vertebra, initial encounter
S33.120D Subluxation of L2/L3 lumbar vertebra, subsequent encounter
S33.120S Subluxation of L2/L3 lumbar vertebra, sequela
S33.121A Dislocation of L2/L3 lumbar vertebra, initial encounter
S33.121D Dislocation of L2/L3 lumbar vertebra, subsequent encounter
S33.121S Dislocation of L2/L3 lumbar vertebra, sequela
S33.130A Subluxation of L3/L4 lumbar vertebra, initial encounter
S33.130D Subluxation of L3/L4 lumbar vertebra, subsequent encounter
S33.130S Subluxation of L3/L4 lumbar vertebra, sequela
S33.131A Dislocation of L3/L4 lumbar vertebra, initial encounter
S33.131D Dislocation of L3/L4 lumbar vertebra, subsequent encounter
S33.131S Dislocation of L3/L4 lumbar vertebra, sequela
S33.140A Subluxation of L4/L5 lumbar vertebra, initial encounter
S33.140D Subluxation of L4/L5 lumbar vertebra, subsequent encounter
S33.140S Subluxation of L4/L5 lumbar vertebra, sequela
S33.141A Dislocation of L4/L5 lumbar vertebra, initial encounter
S33.141D Dislocation of L4/L5 lumbar vertebra, subsequent encounter
S33.141S Dislocation of L4/L5 lumbar vertebra, sequela

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2022 R4

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 22533, 22558, 22612, 22630 and 22633. This revision is due to the 2022 Annual CPT/HCPCS Code Update and is effective on January 1, 2022.

10/01/2020 R3

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added M80.0AXA, M80.0AXD, M80.0AXG, M80.0AXK, M80.0AXP, M80.0AXS, M80.8AXA, M80.8AXD, M80.8AXG, M80.8AXK, M80.8AXP and M80.8AXS. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/17/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Lumbar Spinal Fusion L37848 LCD and placed in this article.

05/06/2019 R1

All coding located in the Coding Information section has been removed from the related Lumbar Spinal Fusion L37848 LCD and added to this article.

Associated Documents

Related Local Coverage Documents
LCDs
L37848 - Lumbar Spinal Fusion
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/21/2021 01/01/2022 - N/A Currently in Effect You are here
08/24/2020 10/01/2020 - 12/31/2021 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Lumbar
  • Spinal
  • Fusion