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ICD-10/M48.54XA

M48.54XA ICD-10-CM Code: Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 542 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC (MDC 08)
  • MS-DRG 543 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC (MDC 08)
  • MS-DRG 544 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC (MDC 08)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 401 — Vertebral Fractures without Spinal Cord Injury

Other models: CMS-HCC V22 HCC 169 · RxHCC V08 HCC 87

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Official Registry Overview & Definition

Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture is a billable ICD-10-CM diagnosis code (M48.54A).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for M48.54XA in the official ICD-10-CM tabular list.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Change history

No changes recorded for this code — unchanged since the FY2016 baseline of the change ledger.

Verify Before Coding

  • Billable — reportable as written.
  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Contextual Map

Every relationship of M48.54XA in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • M00-M99 — Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) (M00-M99) [Hierarchy]
  • M45-M49 — Spondylopathies [Hierarchy]

Referenced by Excludes1 notes

  • G55 — Nerve root and plexus compressions in diseases classified elsewhere [Excludes1](via M48.-): “nerve root compression (due to) (in) spondylopathies (M46.-, M48.-)” · check together

Clinical classification (CCSR)

  • MUS016 — Stress fracture, initial encounter [CCSR]

Risk adjustment (CMS-HCC)

  • HCC 401 — Vertebral Fractures without Spinal Cord Injury [CMS-HCC]

Potential MS-DRG

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”
  • DRG 542 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC [MS-DRG]: “PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC (MDC 08)”
  • DRG 543 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC [MS-DRG]: “PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC (MDC 08)”
  • DRG 544 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC [MS-DRG]: “PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC (MDC 08)”
  • DRG 791 — PREMATURITY WITH MAJOR PROBLEMS [MS-DRG]: “PREMATURITY WITH MAJOR PROBLEMS (MDC 15)”
  • DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS [MS-DRG]: “FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)”

MDC crossing · procedures (18508)

  • MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue [MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period [MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 005T0ZZ — Destruction of Spinal Meninges, Open Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T3ZZ — Destruction of Spinal Meninges, Percutaneous Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T4ZZ — Destruction of Spinal Meninges, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Endoscopic Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0Z3 — Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0ZZ — Destruction of Cervical Spinal Cord, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • and 18503 more

Nearest codes (40)

  • M48 — Other spondylopathies [Sibling]
  • M48.50XA — Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture [Sibling]
  • M48.50XD — Collapsed vertebra, not elsewhere classified, site unspecified, subsequent encounter for fracture with routine healing [Sibling]
  • M48.50XG — Collapsed vertebra, not elsewhere classified, site unspecified, subsequent encounter for fracture with delayed healing [Sibling]
  • M48.50XS — Collapsed vertebra, not elsewhere classified, site unspecified, sequela of fracture [Sibling]
  • M48.51 — Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region [Sibling]
  • M48.51XA — Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture [Sibling]
  • M48.51XD — Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, subsequent encounter for fracture with routine healing [Sibling]
  • and 32 more

Referenced by Other Codes

Clinical classification (AHRQ CCSR):MUS016 — Stress fracture, initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 214 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 542 (MDC 08), DRG 543 (MDC 08), DRG 544 (MDC 08), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name M48.54XA or its code family.

1 Excludes1 notes: G55 (via M48.-).

Frequently Asked Questions (FAQ) & Clinical Guidance

Does M48.54XA require a 7th character?

Yes. The appropriate 7th character is to be added to each code from subcategory M48.5:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M48.54XA in its code family, with their registry titles.

  • M48.53XA — Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture
  • M48.53XD — Collapsed vertebra, not elsewhere classified, cervicothoracic region, subsequent encounter for fracture with routine healing
  • M48.53XG — Collapsed vertebra, not elsewhere classified, cervicothoracic region, subsequent encounter for fracture with delayed healing
  • M48.53XS — Collapsed vertebra, not elsewhere classified, cervicothoracic region, sequela of fracture
  • M48.54 — Collapsed vertebra, not elsewhere classified, thoracic region
  • M48.54XD — Collapsed vertebra, not elsewhere classified, thoracic region, subsequent encounter for fracture with routine healing
  • M48.54XG — Collapsed vertebra, not elsewhere classified, thoracic region, subsequent encounter for fracture with delayed healing
  • M48.54XS — Collapsed vertebra, not elsewhere classified, thoracic region, sequela of fracture
  • M48.55 — Collapsed vertebra, not elsewhere classified, thoracolumbar region
  • M48.55XA — Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture

View all codes in the M48 family