Is ICD-10-CM code M43 billable?

No, M43 (Other deforming dorsopathies) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code M43 belong to?

M43 belongs to Chapter 13 of the ICD-10-CM tabular list: M00–M99 (Diseases of the Musculoskeletal System and Connective Tissue).

M43Not billable, use a more specific code below

Other deforming dorsopathies

In Deforming dorsopathies (M40-M43), chapter 13: Diseases of the Musculoskeletal System and Connective Tissue

50 billable codes under M43: none are a CC or MCC; none map to an HCC.

Instructional notes

Excludes1: not coded here, use a different code

congenital spondylolysis and spondylolisthesis (Q76.2)
hemivertebra (Q76.3-Q76.4)
Klippel-Feil syndrome (Q76.1)
lumbarization and sacralization (Q76.4)
platyspondylisis (Q76.4)
spina bifida occulta (Q76.0)
spinal curvature in osteoporosis (M80.-)
spinal curvature in Paget's disease of bone [osteitis deformans] (M88.-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers site and laterality, acute injury versus chronic musculoskeletal conditions, 7th characters for pathologic fractures, osteoporosis with or without current fracture, and multisystem inflammatory syndrome.

Site and laterality (page 60)
Acute traumatic versus chronic or recurrent musculoskeletal conditions (page 61)
Coding of Pathologic Fractures (page 61)
Osteoporosis (page 61)
Multisystem Inflammatory Syndrome (page 62)

Read Section I.C.13 (page 60)

All codes under M43

M43 can't be used on a claim. Pick a billable code below; grey headings group them.

M43 MS-DRGs

As the principal diagnosis, the billable codes under M43 group to these 8 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 551 Medical Back Problems with MCC (40 of 50 codes)
DRG 552 Medical Back Problems without MCC (40 of 50 codes)
DRG 564 Other Musculoskeletal System and Connective Tissue Diagnoses with MCC (10 of 50 codes)
DRG 565 Other Musculoskeletal System and Connective Tissue Diagnoses with CC (10 of 50 codes)
DRG 566 Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCC (10 of 50 codes)
DRG 456 Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or Infection with MCC (7 of 50 codes)
DRG 457 Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or Infection with CC (7 of 50 codes)
DRG 458 Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or Infection without CC/MCC (7 of 50 codes)

Other codes that refer to M43

Notes on these codes point to M43.

M95 Excludes2: deforming dorsopathies (M40-M43)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Spine Injuries and Disorders

Your backbone, or spine, is made up of 26 bone discs called vertebrae. The vertebrae protect your spinal cord and allow you to stand and bend. A number of problems can change the structure of the spine or damage the vertebrae and surrounding tissue. They include:

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.