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M48.55XS vs M84.68

M48.55XS (Collapsed vertebra, not elsewhere classified, thoracolumbar region, sequela of fracture) compared with M84.68 (Pathological fracture in other disease, other site), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.

Relationship

Conflict

Excludes1 conflict

M48.55XS
Collapsed vertebra, not elsewhere classified, thoracolumbar region, sequela of fracture
↔
M84.68
Pathological fracture in other disease, other site

Not coded here — these two are mutually exclusive.

“pathological fracture of vertebra due to other diagnosis (M84.68)”

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. M48.55XS carries an Excludes1 note covering M84.68: “pathological fracture of vertebra due to other diagnosis (M84.68)”

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

M48.55XSCollapsed vertebra, not elsewhere classified, thoracolumbar region, sequela of fractureM84.68Pathological fracture in other disease, other site
Billing statusBillableNon-billable header
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, thoracolumbar region, sequela of fracture is a billable ICD-10-CM diagnosis code (M48.55S).Pathological fracture in other disease, other site is a non-billable ICD-10-CM category code (M84.68).
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 M84.6:
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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