Fatigue fracture of vertebra, site unsp, sequela of fracture

This code signifies a vertebral fatigue fracture that has healed or is in a chronic state, with the current encounter addressing a residual condition or complication directly resulting from the original fracture. It indicates that the specific location of the affected vertebra is not documented.

Apply this code when a patient presents with a long-term effect or complication (e.g., chronic pain, deformity, neurological deficit) directly attributable to a past vertebral fatigue fracture. Documentation should clearly state the sequela and link it to a previously sustained fatigue fracture of an unspecified vertebra.

• Always sequence the code for the specific sequela (e.g., chronic pain, kyphosis) first, followed by this sequela code.
• Avoid using this code for acute or active fatigue fractures; those require codes from the M48.4- series without the "S" seventh character.
• Ensure documentation explicitly states "sequela" or a similar term indicating a residual condition from a past fracture, and that the vertebral site is not specified.