ICD-10-CM · Spine

M48.35

Traumatic spondylopathy localized to the thoracolumbar junction (T12–L1 region), representing vertebral or spinal column pathology caused by mechanical trauma rather than degenerative or inflammatory disease.

Verified May 8, 2026 · 6 sources ↓

Status: Billable
Chapter: 13
Related CPT: 18
Region: Spine

Drawn from CDCICD10DataCMSAAPC

Documentation tips

What should appear in the chart to support M48.35.

Source · Editorial brief grounded in 6 cited references ↓

Explicitly name the region as 'thoracolumbar' or identify T12–L1 as the affected level — vague terms like 'lower thoracic' or 'upper lumbar' alone may not map cleanly to M48.35.
Document the causative traumatic event (date, mechanism — e.g., motor vehicle accident, fall, axial loading injury) to distinguish traumatic spondylopathy from degenerative spondylopathy (M47.x) or inflammatory spondylopathy (M45.x).
Record imaging findings that confirm structural spinal pathology at the thoracolumbar level — X-ray, CT, or MRI findings such as endplate changes, kyphotic deformity, or ligamentous injury support medical necessity.
If fusion or surgical intervention is planned, document failed or exhausted conservative care (bracing, physical therapy, pain management) and functional limitations to satisfy payer medical necessity criteria.
Distinguish whether an acute vertebral fracture is also present — if so, an S-code (e.g., S22.0xxA) should be the principal diagnosis for the fracture, with M48.35 used only if the spondylopathic condition is a separate, documented diagnosis.

Related CPT procedures

Procedure codes commonly billed with M48.35. Linking the right diagnosis to the right procedure is what establishes medical necessity.

Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis

22533 $1,547.80

Spinal fusion of a lumbar vertebral segment performed through a lateral extracavitary approach, including minimal discectomy to prepare the interspace (not performed solely for decompression).

22534 $323.65

Add-on code for lateral extracavitary arthrodesis at each additional thoracic or lumbar vertebral segment beyond the first.

22558 $1,423.88

Anterior interbody arthrodesis of the lumbar spine using an anterior or anterolateral approach, including the minimal discectomy required to prepare the interspace for fusion.

22612 $1,467.64

Posterior or posterolateral lumbar arthrodesis of a single interspace, performed via a posterior approach with bone graft and typically pedicle screw fixation to achieve vertebral segment fusion.

22630 $1,510.72

Posterior interbody arthrodesis of a single lumbar interspace, including laminectomy and/or discectomy performed to prepare the interspace for fusion rather than for decompression.

22800 $1,312.99

Posterior spinal arthrodesis for deformity correction spanning up to 6 vertebral segments, with or without application of a body cast.

22840 $668.35

Posterior non-segmental instrumentation placed during spinal surgery, using rods, hooks, or wires that span multiple vertebral levels without anchoring at each intervening segment.

22842 $680.04

Posterior segmental spinal instrumentation spanning 3 to 6 vertebral segments, reported as an add-on to the primary spinal procedure code.

72100 $40.42

Radiologic examination of the lumbosacral spine capturing two or three views, used to evaluate the lumbar vertebrae and sacrum for injury, degeneration, or structural abnormality.

72110 $53.44

Radiologic examination of the lumbar spine (lumbosacral) with a minimum of four views, including oblique and/or bending views.

72114 $61.79

Radiologic examination of the lumbosacral spine, complete series with bending (flexion/extension) views — minimum of 6 views total.

72120 $42.09

Radiologic examination of the lumbosacral spine using bending views only, minimum of four views, to assess spinal flexibility and alignment.

72148 $191.72

Non-contrast MRI of the lumbar spine used to evaluate disc pathology, spinal stenosis, nerve root compression, and other structural abnormalities without administration of contrast material.

72158 $318.31

MRI of the lumbar spinal canal and its contents performed first without contrast, then repeated after contrast administration for enhanced visualization.

63005 $1,192.41

Laminectomy at one or two lumbar vertebral segments for exploration or decompression of the spinal cord or cauda equina, performed without facetectomy, foraminotomy, or discectomy — excluding spondylolisthesis cases.

72131 View procedure details

72132 View procedure details

72133 View procedure details

Common coding pitfalls

The recurring mistakes coders make with M48.35 and adjacent codes.

Source · Editorial brief grounded in CDC ICD-10-CM tabular guidance, AAOS coding references, and cited references ↓

Appending a 7th-character extension (A, D, or S) to M48.35 — M48.3x codes are 5-character codes with no 7th-character extension; doing so creates an invalid code.
Using M48.35 for an acute traumatic vertebral fracture — fractures are coded with S22.x or S32.x codes; M48.35 applies to the spondylopathic condition, not the fracture event itself.
Defaulting to M48.30 (traumatic spondylopathy, site unspecified) when documentation clearly identifies the thoracolumbar region — always capture the highest specificity the record supports.
Confusing M48.35 (thoracolumbar region, T12–L1) with M48.34 (thoracic region) or M48.36 (lumbar region) — the thoracolumbar region is a distinct anatomical classification and should only be used when the junction level is documented.
Submitting M48.35 without supporting imaging or a documented traumatic mechanism — payers covering fusion (per CMS A56396) expect records to substantiate both the structural finding and its traumatic etiology.

Clinical context

Source · Editorial summary grounded in 6 cited references ↓

M48.35 captures traumatic spondylopathy at the thoracolumbar region — the junction between the thoracic and lumbar spine, generally corresponding to T12–L1. Use this code when the spondylopathy is attributable to a traumatic event (e.g., compression injury, flexion-distraction mechanism, axial loading) and the clinical documentation specifically identifies the thoracolumbar region as the affected site. It is a billable, terminal code under parent M48.3 (Traumatic spondylopathy).

M48.35 appears on the CMS Lumbar Spinal Fusion billing and coding article (A56396) as a code that supports medical necessity for fusion procedures, alongside M48.36 (lumbar) and M48.37 (lumbosacral). It also appears in the CMS Chiropractic Services article (A56273) as a covered diagnosis. When the traumatic injury spans multiple spinal regions or cannot be localized to the thoracolumbar junction specifically, evaluate whether a multi-site or unspecified code better reflects the record.

Note that M48.3x codes do NOT carry 7th-character extensions (A/D/S) — those are reserved for certain other M48 subcategories such as fatigue fractures. If an acute traumatic vertebral fracture is present, consider S-code fracture codes in chapter 19 (S22.x, S32.x) rather than M48.35, which is appropriate for the spondylopathic sequela or chronic/subacute traumatic condition of the thoracolumbar spine.

Sibling codes

Other billable codes under M48.3 (laterality / anatomic variants).

M48.34

Traumatic spondylopathy, thoracic region

M48.38

Traumatic spondylopathy, sacral and sacrococcygeal region

M48.32

Traumatic spondylopathy, cervical region

M48.31

Traumatic spondylopathy, occipito-atlanto-axial region

M48.37

Traumatic spondylopathy, lumbosacral region

M48.33

Traumatic spondylopathy, cervicothoracic region

M48.36

Traumatic spondylopathy, lumbar region

M48.30

Traumatic spondylopathy, site unspecified

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Does M48.35 require a 7th character like other traumatic spinal codes?

No. M48.35 is a 5-character billable code with no 7th-character extension. Only certain M48 subcategories — such as fatigue fractures (M48.4x) and stress fractures (M48.5x) — use 7th characters. Adding A, D, or S to M48.35 produces an invalid code.

02When should I use M48.35 instead of an S-code fracture code?

Use an S-code (S22.0xx–, S32.0xx–) when coding an acute traumatic vertebral fracture as the principal diagnosis. M48.35 is appropriate for the spondylopathic condition — chronic structural damage or instability attributable to a prior traumatic event — not the acute fracture itself. Both may appear on the same claim if separately documented.

03What is the thoracolumbar region for ICD-10-CM purposes?

The thoracolumbar region in the M48 code family refers to the T12–L1 junction. It is a distinct anatomical classification, separate from the thoracic region (M48.34) and lumbar region (M48.36). Only use M48.35 when the provider's documentation identifies pathology at or spanning that junction.

04Is M48.35 covered as a medical necessity code for lumbar spinal fusion?

Yes. CMS Billing and Coding Article A56396 (Lumbar Spinal Fusion) lists M48.35 explicitly in Group 1 codes that support medical necessity, alongside M48.36 and M48.37. Ensure the operative and clinical documentation substantiates the traumatic etiology and failure of conservative care.

05Can M48.35 be used for chiropractic claims?

Yes. CMS Chiropractic Services article A56273 lists M48.35 as a covered diagnosis. Chiropractic claims must still meet active/corrective treatment requirements and carry the AT modifier per Medicare documentation rules.

06How do I choose between M48.35 and M48.36 when the injury spans T12 and L1–L2?

If the provider documents pathology centered at or spanning the T12–L1 junction, M48.35 (thoracolumbar) is appropriate. If the primary involvement is L1–L5 without junction specificity, M48.36 (lumbar) is the better fit. When documentation is ambiguous, query the provider rather than defaulting to unspecified.

07What imaging documentation best supports M48.35 on a fusion claim?

CT or MRI findings at T12–L1 documenting kyphotic deformity, posterior ligamentous complex disruption, endplate injury, or instability best support this code on a fusion claim. Plain film evidence of deformity or malalignment also contributes, but cross-sectional imaging is typically expected by payers for surgical authorization.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the traumatic mechanism (event type, date, force direction), the specific vertebral levels involved at the thoracolumbar junction, and imaging-confirmed structural findings (kyphosis, endplate disruption, ligamentous injury on MRI/CT) that distinguish this from degenerative disease. That documentation prevents downcoding to M48.30 (unspecified site) and blocks payer denials on fusion claims that require medical necessity evidence tied to a named traumatic etiology.

See how Mira captures M48.35 documentation