M48.46XD vs M84.4

M48.46XD (Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with routine healing) compared with M84.4 (Pathological fracture, not elsewhere classified), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.

Relationship

Conflict

Excludes1 conflict

M48.46XD

Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with routine healing

↔

M84.4

Pathological fracture, not elsewhere classified

Not coded here — these two are mutually exclusive.

“pathological fracture NOS (M84.4-)”

An Excludes1 note means the two conditions cannot occur together, so the pair should not be reported for the same encounter. The sole exception is when the conditions are documented as unrelated to each other.

Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Can these codes be reported together?

No — do not report together. M48.46XD carries an Excludes1 note covering M84.4: “pathological fracture NOS (M84.4-)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Side by side

	M48.46XDFatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with routine healing	M84.4Pathological fracture, not elsewhere classified
Billing status	Billable	Non-billable header
Classification	M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)	M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
Definition	Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with routine healing is a billable ICD-10-CM diagnosis code (M48.46D).	Pathological fracture, not elsewhere classified is a non-billable ICD-10-CM category code (M84.4).
7th character	The appropriate 7th character is to be added to each code from subcategory M48.4:	The appropriate 7th character is to be added to each code from subcategory M84.4:
Includes	—	Chronic fracture Pathological fracture NOS

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Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources