M48.56XA ICD-10-CM Code: Collapsed vertebra, not elsewhere classified, lumbar 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
Official Tabular Instructional Notes
Sequencing, inclusion, and exclusion notes published for M48.56XA 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).
- current injury - see Injury of spine, by body region
- fatigue fracture of vertebra (M48.4) Compare M48.56XA vs M48.4 →
- pathological fracture of vertebra due to neoplasm (M84.58) Compare M48.56XA vs M84.58 →
- pathological fracture of vertebra due to other diagnosis (M84.68) Compare M48.56XA vs M84.68 →
- pathological fracture of vertebra due to osteoporosis (M80.-) Compare M48.56XA vs M80 →
- pathological fracture NOS (M84.4-) Compare M48.56XA vs M84.4 →
- stress fracture of vertebra (M48.4-) Compare M48.56XA vs M48.4 →
- traumatic fracture of vertebra (S12.-, S22.-, S32.-) Compare M48.56XA vs S12 →
Frequently Compared Codes
The official Excludes notes on M48.56XA name these codes. Each comparison page covers when the two can — or must not — be reported together.
Change history
No changes recorded for this code — unchanged since the FY2016 baseline of the change ledger.
Verify Before Coding
- 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.
Relationships & Classification
Other codes that name M48.56XA or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.
1 Excludes1 notes: G55 (via M48.-).
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.
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.
Related Codes
Same clinical process (MS-DRG)
Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.
M48.45XA — Fatigue fracture of vertebra, thoracolumbar region, initial encounter for fracture, M48.46XA — Fatigue fracture of vertebra, lumbar region, initial encounter for fracture, M48.47XA — Fatigue fracture of vertebra, lumbosacral region, initial encounter for fracture, M48.48XA — Fatigue fracture of vertebra, sacral and sacrococcygeal region, initial encounter for fracture, M48.50XA — Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture, M48.51XA — Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture, M48.52XA — Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture, M48.53XA — Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture, M48.54XA — Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture, M48.55XA — Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture, M48.57XA — Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture, M48.58XA — Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture, M80.00XA — Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture, M80.011A — Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture, M80.012A — Age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture, M80.019A — Age-related osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture, M80.021A — Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture, M80.022A — Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture, M80.029A — Age-related osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture, M80.031A — Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture, +217 more
Same CMS-HCC risk category (V28)
CMS maps these diagnoses to the same Hierarchical Condition Category (Vertebral Fractures without Spinal Cord Injury) for risk-adjusted payment.
M48.50XA — Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture, M48.51XA — Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture, M48.52XA — Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture, M48.53XA — Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture, M48.54XA — Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture, M48.55XA — Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture, M48.57XA — Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture, M48.58XA — Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture, M80.08XA — Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture, M80.88XA — Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture, S12.000A — Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture, S12.000B — Unspecified displaced fracture of first cervical vertebra, initial encounter for open fracture, S12.001A — Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture, S12.001B — Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture, S12.01XA — Stable burst fracture of first cervical vertebra, initial encounter for closed fracture, S12.01XB — Stable burst fracture of first cervical vertebra, initial encounter for open fracture, S12.02XA — Unstable burst fracture of first cervical vertebra, initial encounter for closed fracture, S12.02XB — Unstable burst fracture of first cervical vertebra, initial encounter for open fracture, S12.030A — Displaced posterior arch fracture of first cervical vertebra, initial encounter for closed fracture, S12.030B — Displaced posterior arch fracture of first cervical vertebra, initial encounter for open fracture, +318 more
Same clinical category (CCSR)
AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Stress fracture, initial encounter).
M48.45XA — Fatigue fracture of vertebra, thoracolumbar region, initial encounter for fracture, M48.46XA — Fatigue fracture of vertebra, lumbar region, initial encounter for fracture, M48.47XA — Fatigue fracture of vertebra, lumbosacral region, initial encounter for fracture, M48.48XA — Fatigue fracture of vertebra, sacral and sacrococcygeal region, initial encounter for fracture, M48.50XA — Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture, M48.51XA — Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture, M48.52XA — Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture, M48.53XA — Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture, M48.54XA — Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture, M48.55XA — Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture, M48.57XA — Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture, M48.58XA — Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture, M84.30XA — Stress fracture, unspecified site, initial encounter for fracture, M84.311A — Stress fracture, right shoulder, initial encounter for fracture, M84.312A — Stress fracture, left shoulder, initial encounter for fracture, M84.319A — Stress fracture, unspecified shoulder, initial encounter for fracture, M84.321A — Stress fracture, right humerus, initial encounter for fracture, M84.322A — Stress fracture, left humerus, initial encounter for fracture, M84.329A — Stress fracture, unspecified humerus, initial encounter for fracture, M84.331A — Stress fracture, right ulna, initial encounter for fracture, +35 more
Lab tests where this diagnosis supports Medicare coverage (NCD)
Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.
Contextual Map
Every relationship of M48.56XA 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]
- M48.52XA — Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture [Sibling]
- M48.52XD — Collapsed vertebra, not elsewhere classified, cervical region, subsequent encounter for fracture with routine healing [Sibling]
- M48.52XG — Collapsed vertebra, not elsewhere classified, cervical region, subsequent encounter for fracture with delayed healing [Sibling]
- M48.52XS — Collapsed vertebra, not elsewhere classified, cervical region, sequela of fracture [Sibling]
- M48.53 — Collapsed vertebra, not elsewhere classified, cervicothoracic region [Sibling]
- M48.53XA — Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture [Sibling]
- M48.53XD — Collapsed vertebra, not elsewhere classified, cervicothoracic region, subsequent encounter for fracture with routine healing [Sibling]
- and 32 more
Frequently Asked Questions (FAQ) & Clinical Guidance
Does M48.56XA 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 M48.56XA in its code family, with their registry titles.
- 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
- M48.56 — Collapsed vertebra, not elsewhere classified, lumbar region
- 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
- M48.57 — Collapsed vertebra, not elsewhere classified, lumbosacral region
- M48.57XA — Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture