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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.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
8 Excludes1
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 169 · RxHCC V08 category 87

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

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

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M48.56XA in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on M48.56XA itself; “inherited from” names the category or block whose note applies here.

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).

Source: inherited from M48.5

7th Character Guide

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

  • A — initial encounter for fracture (this page’s code)
  • D — subsequent encounter for fracture with routine healing
  • G — subsequent encounter for fracture with delayed healing
  • S — sequela of fracture

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

M48.56XA, M48.56XD, M48.56XG, M48.56XS

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for M48.56XA

MedCoder structured workflow — derived from this code’s own official record

Before you code M48.56XA

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on M48.56XA; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. This page’s code carries “A”. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

    See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with M48.56XA. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in M48.56XA’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewM48.4, M84.58, M84.68, M80, M84.4, S12

  2. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider M48.56XA. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Encounter type
Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).
Open or closed; displaced or nondisplaced
Defaults apply when the record is silent: closed, and displaced (Guidelines I.C.19.c).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting M48.56XA(8 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with M48.56XA: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareM48.4, M84.58, M84.68, M80, M84.4, S12

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition M48.56XA describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewM48.4, M84.58, M84.68, M80, M84.4, S12

Documentation: The patient returns during the healing or recovery phase after active treatment of the same condition.

Coding question: Which 7th character applies?

Path: Review the official 7th-character definitions for this family in the 7th Character Guide.

Reason: “Initial encounter” means active treatment, not the first visit; care during recovery takes “subsequent encounter”, and a complication arising from the original condition takes “sequela” (Guidelines I.C.19.a).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture is a billable ICD-10-CM diagnosis code (M48.56XA).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

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 in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

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.

Referenced by 1 Excludes1 note: G55 — Nerve root and plexus compressions in diseases classified elsewhere (via M48.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 7 Excludes2 notes: M20 — Acquired deformities of fingers and toes (via M48.-), M20-M25 — Other joint disorders (M20-M25) (via M48.-), M21 — Other acquired deformities of limbs (via M48.-), M22 — Disorder of patella (via M48.-), M23 — Internal derangement of knee (via M48.-), M24 — Other specific joint derangements (via M48.-), M25 — Other joint disorder, not elsewhere classified (via M48.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

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, +193 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

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Collapse”; these codes share that main term but sit in a different category of the Tabular List.

J34.8200 — Internal nasal valve collapse, unspecified (nasal valve, internal), J34.8201 — Internal nasal valve collapse, static (nasal valve, internal, static), J34.8202 — Internal nasal valve collapse, dynamic (nasal valve, internal, dynamic), J34.8210 — External nasal valve collapse, unspecified (nasal valve, external), J34.8211 — External nasal valve collapse, static (nasal valve, external, static), J34.8212 — External nasal valve collapse, dynamic (nasal valve, external, dynamic), J34.829 — Nasal valve collapse, unspecified (nasal valve), J39.8 — Other specified diseases of upper respiratory tract (trachea), J98.09 — Other diseases of bronchus, not elsewhere classified (tracheobronchial), J98.19 — Other pulmonary collapse (lung), M80.88 — Other osteoporosis with current pathological fracture, vertebra(e) (vertebra, in, osteoporosis), M84.58 — Pathological fracture in neoplastic disease, other specified site (vertebra, in, neoplasm), M95.0 — Acquired deformity of nose (nose), O08.3 — Shock following ectopic and molar pregnancy (vascular, following ectopic or molar pregnancy), O29.02 — Pressure collapse of lung due to anesthesia during pregnancy (lung, pressure due to anesthesiaor other sedation, in pregnancy), O74.1 — Other pulmonary complications of anesthesia during labor and delivery (lung, pressure due to anesthesiaor other sedation, during labor and delivery), O75.1 — Shock during or following labor and delivery (during or, after labor and delivery), O89.09 — Other pulmonary complications of anesthesia during the puerperium (lung, pressure due to anesthesiaor other sedation, postpartum, puerperal), P29.89 — Other cardiovascular disorders originating in the perinatal period (vascular, newborn), Q16.5 — Congenital malformation of inner ear (labyrinth, membranous), +10 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.

Partial Thromboplastin Time (PTT) Test

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.

Run M48.56XA with these 8 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 401 — Vertebral Fractures without Spinal Cord Injury [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Does M48.56XA require a 7th character?

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

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M48.56XA in its code family, with their registry titles.

View all codes in the M48 family