2027 ICD-10-CM Diagnosis Code M48.46XAFatigue fracture of vertebra, lumbar region, initial encounter for fracture
M48.46XA is a billable ICD-10-CM diagnosis code for fatigue fracture of vertebra, lumbar region, initial encounter for fracture. The 7th character A means initial encounter for fracture, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 542 through 544. Coders also document this condition as stress fracture of lumbar vertebra. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Stress fracture, initial encounter.
Code Identity
Code Classification
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when M48.46XA is part of the patient record.
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older
High Priority: YES
Measure Type: Process
Submission Methods: Claims, Registry
Description: Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication.
Osteoporosis Management in Women Who Had a Fracture
High Priority: NO
Measure Type: Process
Submission Methods: Claims, Registry
Description: The percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the 180 days after the fracture.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Stress fracture of lumbar vertebra
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M48.46XA: its own notes plus those printed at M48.4 and Chapter 13. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- The appropriate 7th character is to be added to each code from subcategory M48.4:
- Ainitial encounter for fracture this code
- Dsubsequent encounter for fracture with routine healing
- Gsubsequent encounter for fracture with delayed healing
- Ssequela of fracture
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M48.46XA, its category, or a range that includes it.
Excludes1 3
These codes carry an Excludes1 note naming M48.46XA: they are not reported together with it, unless the two conditions are unrelated.
- G55 Nerve root and plexus compressions in diseases classified elsewherenerve root compression (due to) (in) spondylopathies (M46.-, M48.-) names M48.-, which includes this code
- M48.5 Collapsed vertebra, not elsewhere classifiedfatigue fracture of vertebra (M48.4) names M48.4, which includes this code
- M48.5 Collapsed vertebra, not elsewhere classifiedstress fracture of vertebra (M48.4-) names M48.4-, which includes this code
Excludes2 2
These codes carry an Excludes2 note naming M48.46XA: its condition is not part of those codes, and both may be reported when the patient has both.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Fractures
A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.
The full article covers:
- What is a fracture?
- What are the different types of fractures?
- What causes fractures?
- What are the symptoms of a fracture?
- How are fractures diagnosed?
- What are the treatments for fractures?
- Can fractures be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M48.46XA to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M48.46XAOverview
Is M48.46XA (Fatigue fracture of vertebra, lumbar region) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report fatigue fracture of vertebra, lumbar region, initial encounter for fracture on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character A in M48.46XA mean?
The final character A marks the initial encounter: use it while the patient is receiving active treatment for fatigue fracture of vertebra, lumbar region, such as an emergency visit or first evaluation. In this category the CMS Tabular List defines A as "initial encounter for fracture".
What MS-DRG does M48.46XA group to?
When fatigue fracture of vertebra, lumbar region, initial encounter for fracture is the principal diagnosis on an inpatient stay, it groups to MS-DRG 543, 544, 542, with relative weights from 0.7404 to 1.7208 depending on complications. Higher weights mean higher Medicare reimbursement.
Can M48.46XA be reported with a code from M84.4?
Not as a rule. The Excludes1 note at M48.4, which applies to M48.46XA, lists "pathological fracture NOS (M84.4-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of M48.46XA?
Under the General Equivalence Mappings, fatigue fracture of vertebra, lumbar region, initial encounter for fracture converts to ICD-9-CM 733.95 (stress fracture bone NEC). The mapping is approximate, so confirm the match fits the documentation.
