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M48.5 vs M84.40XG

M48.5 (Collapsed vertebra, not elsewhere classified) compared with M84.40XG (Pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing), from the official CMS tabular data.

Summary

These codes should not be reported together because M48.5’s tabular entry lists M84.40XG under Excludes1.

Official rule
What is different?

The conditions named and billing status.M48.5 is “Collapsed vertebra, not elsewhere classified”; M84.40XG is “Pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing”. M48.5 is a non-billable header; M84.40XG is billable.

Registry fact

Can these codes be reported together?

No.M48.5’s entry carries an Excludes1 note covering M84.40XG: “pathological fracture NOS (M84.4-)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.M48.5’s tabular entry: “pathological fracture NOS (M84.4-)”. The note covers M84.40XG.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. M84.40XG carries 2 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.M48.5 is a non-billable header, but M84.40XG is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Conflict

Excludes1 conflict

M48.5
Collapsed vertebra, not elsewhere classified
↔
M84.40XG
Pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing

What we found

No — do not report together.M48.5 carries an Excludes1 note covering M84.40XG: “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).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

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 / rule

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

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

M48.5Collapsed vertebra, not elsewhere classifiedM84.40XGPathological fracture, unspecified site, subsequent encounter for fracture with delayed healing
Billing statusNon-billable header

Report instead: M48.50XA, M48.50XD, M48.50XG, M48.50XS, M48.51XA

Billable
ClassificationM00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
DefinitionCollapsed vertebra, not elsewhere classified is a non-billable ICD-10-CM category code (M48.5).Pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing is a billable ICD-10-CM diagnosis code (M84.40XG).
7th characterThe appropriate 7th character is to be added to each code from subcategory M48.5:The appropriate 7th character is to be added to each code from subcategory M84.4:
Includes
Collapsed vertebra NOS
Compression fracture of vertebra NOS
Wedging of vertebra NOS
—
Excludes1
current injury - see Injury of spine, by body region
fatigue fracture of vertebra (M48.4)
pathological fracture of vertebra due to neoplasm (M84.58)
pathological fracture of vertebra due to other diagnosis (M84.68)
pathological fracture of vertebra due to osteoporosis (M80.-)
pathological fracture NOS (M84.4-)
stress fracture of vertebra (M48.4-)
traumatic fracture of vertebra (S12.-, S22.-, S32.-)
collapsed vertebra NEC (M48.5)
pathological fracture in neoplastic disease (M84.5-)
pathological fracture in osteoporosis (M80.-)
pathological fracture in other disease (M84.6-)
stress fracture (M84.3-)
traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)
Excludes2—
personal history of (healed) pathological fracture (Z87.311)
traumatic fracture of bone-see fracture, by site

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources