Prior authorization request form Form

Lumbar Fusion and Intervertebral Fusion Devices

Last Review Date: April 10, 2026 
Number: MG.MM.SU.55cC2

Medical Guideline Disclaimer The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the member meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request preauthorization or post-payment review. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. This clinical policy is not intended to pre-empt the judgment of the reviewing medical director or dictate to health care providers how to practice medicine. Health care providers are expected to exercise their medical judgment in rendering appropriate care. Health care providers are expected to exercise their medical judgment in rendering appropriate care.
EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary.
If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. Identification of selected brand names of devices, tests and procedures in a medical coverage policy is for reference only and is not an endorsement of any one device, test or procedure over another. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication.
EmblemHealth may also use tools developed by third parties, such as the MCG™ Care Guidelines, to assist us in administering health benefits. The MCG™ Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice. EmblemHealth Services Company, LLC, has adopted this policy in providing management, administrative and other services to EmblemHealth Plan, Inc., EmblemHealth Insurance Company, EmblemHealth Services Company, LLC, and Health Insurance Plan of Greater New York (HIP) related to health benefit plans offered by these entities. All of the aforementioned entities are affiliated companies under common control of EmblemHealth Inc. Related Medical Guidelines Artificial Intervertebral Discs Interspinous Distraction Devices

Definitions Spinal fusion surgery is designed to stop motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery; all involve the following: • Addition of bone graft to a spinal segment
• Setting up biological response to create artificial induction of bone ossification that enables bone graft to grow between two vertebral elements resulting in bone fusion (aka arthrodesis) • Arresting joint-segment motion — achieved through boney fusion creation of one fixed bone that replaces a mobile joint
Spinal access may be achieved through anterior, posterior and lateral approaches utilizing open surgical (large incision) or minimally invasive/minimal access techniques. (Tables 1 and 2) The two main types of fusion (which may be used in conjunction with each other) are:  Posterolateral fusion — places bone graft between transverse processes in back of the spine; vertebrae then fixed in place with screws and/or wire through the pedicles of each vertebra attaching to a metal rod on each side of the vertebrae  Interbody fusion — places bone graft between vertebrae in area usually occupied by the intervertebral disc; fusion then occurs between endplates of the vertebrae

Types of fusion instrumentation for rigid stabilization consists of pedicle screws, cages/dynamic stabilization devices.

Table 1: Covered Open/Minimally Invasive/Minimal Access Fusion Procedures when clinical criteria are met. Procedure Access Approach Visualization Anterior lumbar interbody fusion (ALIF) Open, MI or laparoscopic Transperitoneal or retroperitoneal

Direct, endoscopic or laparoscopic with fluoroscopic guidance Direct lateral interbody fusion (DLIF) MI Retroperitoneal through transpsoas

Direct, with neurologic monitoring and fluoroscopic guidance Lateral interbody fusion (e.g., extreme lateral interbody fusion [XLIF®]) MI Retroperitoneal through transpsoas

Direct, with neurologic monitoring and fluoroscopic guidance Posterior lumbar interbody fusion (PLIF) Open or MI Incision centered over spine with laminectomy/laminotomy and retraction of nerve Direct, endoscopic or microscopic, with fluoroscopic guidance

Transforaminal lumbar interbody fusion (TLIF) Open or MI Offset from spine, through the intervertebral foramen via unilateral facetectomy Direct, endoscopic or microscopic, with fluoroscopic guidance

Table 2: Non-covered Minimally Invasive/Minimal Access Fusion Procedures (Limitations/Exclusions) Procedure Access Approach Visualization Axial lumbar interbody fusion (AxiaLIF®) MI Pre-sacral space Direct, endoscopic or laparoscopic with fluoroscopic guidance Laparoscopic anterior lumbar interbody fusion (LALIF) (AKA anterior para-axial, trans-sacral or paracoccygeal interbody fusion) Laparoscopic

Transperitoneal or retroperitoneal Direct, endoscopic or laparoscopic with fluoroscopic guidance

Guideline Coverage Position Statements I. EmblemHealth considers the fusion procedures listed in Table 1 to be clinically appropriate when fusion criteria are met. II. EmblemHealth considers cadaveric allograft and demineralized bone matrix (e.g., Accell, AlloFuse, Allogor DBM, Allomatrix, DBX, DynaGraft, DynaGraft, Exactech Resorbable Bone Paste, Grafton DBM, Intergro DBM, Magnifuse, Optefil, Opteform, Origen DBM, OrthoBlast, Ostefil, OsteoSelect, OsteoSponge, and Progenix) to be medically necessary for spinal fusions.
III. EmblemHealth considers recombinant human bone morphogenetic protein-2 (rhBMP-2), including, but not limited to the InFUSE® bone graft, to be medically necessary as an adjunct to instrumented ALIF or posterolateral lumbar intertransverse fusion. (See Limitations/Exclusions for posterior lumbar interbody fusion [PLIF] and TLIF)

Criteria
Lumbar fusion is considered medically necessary when any of the following criteria (1–10) are met.

1. Spinal stenosis; both: A. Any a. Spondylolisthesis (degenerative or isthmic) demonstrated on imaging
   b. Spinal instability demonstrated on imaging
   c. Spinal instability anticipated secondary to need for bilateral or wide decompression with facetectomy or resection of pars interarticularis B. Either a. Neurogenic claudication or radicular pain resulting in significant functional impairment in member who has failed ≥ 3 months of conservative care with documentation of central/lateral recess/or foraminal stenosis on imaging b. Severe or rapidly progressive symptoms of motor loss, neurogenic claudication, disabling radicular pain or cauda equina syndrome
2. Severe progressive idiopathic scoliosis; either: A. Cobb angle > 40°
   B. Spinal cord compression with neurogenic claudication or radicular pain that results in significant functional impairment in a member who has failed ≥ 3 months of conservative care
3. Severe degenerative scoliosis (lumbar or thoracolumbar) with Cobb angle ≤ 30° or significant sagittal imbalance (e.g., sagittal vertical axis ≥ 5 cm); and any: A. Documented progression of deformity with persistent axial (nongraduating) pain and impairment or loss of function unresponsive to ≥ 1 year of nonoperative treatment
   B. Persistent and significant neurogenic symptoms (claudication or radicular pain) with impairment or loss of function, unresponsive to ≥ 1 year of conservative nonsurgical care C. Severe or rapidly progressive symptoms of motor loss, neurogenic claudication, disabling radicular pain or cauda equina syndrome
4. Congenital scoliosis and congenital kyphosis in members with functional and/or neurological impairment
5. Isthmic spondylolisthesis; all: A. Congenital (Wiltse type I) or acquired pars defect (Wiltse II) documented on x-ray B. Persistent back pain (with or without neurogenic symptoms) with impairment or loss of function C. Either unresponsive to ≥ 6 months of conservative nonsurgical care or with severe or rapidly progressive symptoms of motor loss, neurogenic claudication, disabling radicular pain or cauda equina syndrome
6. Recurrent same level disc herniation (post 2 discectomies) occurring at ≥ 3 months post previous surgery; all: A. Recurrent neurogenic symptoms (radicular pain or claudication) or evidence of nerve-root irritation, as demonstrated by a positive nerve-root tension sign, positive femoral tension sign or a corresponding neurologic deficit B. Impairment or loss of function

C. Unresponsive to ≥ 3 months of medical management with severe or rapidly progressive symptoms of motor loss, neurogenic claudication, disabling radicular pain, or cauda equina syndrome D. Neural structure compression/instability documented by imaging at a level and side corresponding to the clinical symptoms

7. Pseudoarthrosis documented on imaging; all: A. ≥ 6 months post initial fusion B. Refractory to medical management with persistent axial back pain (with or without neurogenic symptoms) or with severe or rapidly progressive symptoms of motor loss, neurogenic claudication, disabling radicular pain or cauda equina syndrome C. Member achieved significant symptom-relief prior to current onset of impairment/ functional loss
8. Spinal instability secondary to fracture/pseudoarthrosis, dislocation, infection (including tuberculosis), abscess/cyst or tumor when an extensive surgery is required that could be destabilizing
9. Iatrogenic or degenerative flatback syndrome with significant sagittal imbalance (≥ 5cm) causing functional limitations (e.g., significant pain, decreased ability to ambulate/perform ADLs, etc.)

10. Adjacent level disease; all: A. Persistent back pain (with or without neurogenic symptoms) with impairment or loss of function that is unresponsive to ≥ 3 months of conservative therapy B. Eccentric disc space collapse, spondylolisthesis, acute single level scoliosis or lateral listhesis on imaging C. Symptoms and functional measures correlate with imaging findings
    D. Significant relief achieved for ≥ 6 months after prior fusion

    Limitations/Exclusions

11. The use of instrumentation and bone formation/grafting materials must be used strictly in accordance with FDA-approved labeling. (Note: Osteogenic protein-1 [aka OP-1 implant or bone morphogenic protein-7/rhBMP-7 has been removed from the U.S. market]
12. Repeat lumbar fusion operations will be reviewed on a case-by-case basis upon submission of medical records and imaging studies that demonstrate remediable pathology. The below must also be documented and available for review of repeat fusion requests:
    A. Rationale as to why surgery is preferred over other non-invasive or less invasive treatment procedures.
    B. Signed documentation that the member has participated in the decision-making process and understands the high rate of failure/complications
13. Lumbar fusion is not considered medically necessary if the sole condition is any: C. Chronic nonspecific low back pain without radiculopathy D. Degenerative disc disease without stenosis/spondylolisthesis E. Disc herniation F. Facet syndrome G. Initial discectomy/laminectomy for neural structure decompression

4. The following fusion procedures are not considered medically necessary due to insufficient evidence of therapeutic value: A. Axial lumbar interbody fusion (AxiaLIF®) B. Laparoscopic anterior lumbar interbody fusion (LALIF)
5. Multi-level fusion is not considered medically necessary if clinical criteria are not met for all levels.
6. The use of rhBMP-2 is considered investigational and not medically necessary as an adjunct to PLIF or TLIF.
7. Use of an autograft is not considered medically necessary due to lack of feasibility or secondary to contraindications as follows; any: A. Tissue no longer available, as member received a previous autograft
   B. Insufficient autogenous tissue available for procedure C. Member is deemed an unacceptable candidate for autograft; any: a. > 65 years of age b. Excessive risk of anatomic disruption (e.g., fracture) secondary to harvesting of autograft from donor site c. Increased risk of autograft secondary to concurrent medical conditions/co- morbidities
   d. Poor quality bone (e.g., osteoporosis) e. Obesity f. Presence of morbidity (infection, or fracture) preventing harvesting at autograft donor site

8. Documented compliance of non-smoking three months prior to surgical intervention

   Revision History Apr. 12, 2024 Added congenital scoliosis and congenital kyphosis as covered indications Apr. 8, 2022 Added documented requirement pertaining to smoking Mar. 10, 2027 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar Applicable Procedure Codes 22533 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 22534 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar

22632 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression); each additional interspace 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 22854 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) 22859 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) 22899 Unlisted procedure, spine

Applicable ICD-10 Diagnosis Codes
A18.01 Tuberculosis of spine C41.2 Malignant neoplasm of vertebral column D16.6 Benign neoplasm of vertebral column D33.4 Benign neoplasm of spinal cord G06.1 Intraspinal abscess and granuloma G83.4 Cauda equina syndrome G95.20 Unspecified cord compression G95.29 Other cord compression G95.9 Disease of spinal cord, unspecified M41.04 Infantile idiopathic scoliosis, thoracic region M41.05 Infantile idiopathic scoliosis, thoracolumbar region M41.06 Infantile idiopathic scoliosis, lumbar region M41.07 Infantile idiopathic scoliosis, lumbosacral region M41.114 Juvenile idiopathic scoliosis, thoracic region M41.115 Juvenile idiopathic scoliosis, thoracolumbar region M41.116 Juvenile idiopathic scoliosis, lumbar region M41.117 Juvenile idiopathic scoliosis, lumbosacral region M41.124 Adolescent idiopathic scoliosis, thoracic region M41.125 Adolescent idiopathic scoliosis, thoracolumbar region M41.126 Adolescent idiopathic scoliosis, lumbar region M41.127 Adolescent idiopathic scoliosis, lumbosacral region

M41.24 Other idiopathic scoliosis, thoracic region M41.25 Other idiopathic scoliosis, thoracolumbar region M41.26 Other idiopathic scoliosis, lumbar region M41.27 Other idiopathic scoliosis, lumbosacral region M41.84 Other forms of scoliosis, thoracic region M41.85 Other forms of scoliosis, thoracolumbar region M41.86 Other forms of scoliosis, lumbar region M41.87 Other forms of scoliosis, lumbosacral region M41.9 Scoliosis, unspecified M43.05 Spondylolysis, thoracolumbar region M43.06 Spondylolysis, lumbar region M43.07 Spondylolysis, lumbosacral region M43.15 Spondylolisthesis, thoracolumbar region M43.16 Spondylolisthesis, lumbar region M43.17 Spondylolisthesis, lumbosacral region M46.24 Osteomyelitis of vertebra, thoracic region M46.25 Osteomyelitis of vertebra, thoracolumbar region M46.26 Osteomyelitis of vertebra, lumbar region M46.27 Osteomyelitis of vertebra, lumbosacral region M46.34 Infection of intervertebral disc (pyogenic), thoracic region M46.35 Infection of intervertebral disc (pyogenic), thoracolumbar region M46.36 Infection of intervertebral disc (pyogenic), lumbar region M46.37 Infection of intervertebral disc (pyogenic), lumbosacral region M46.46 Discitis, unspecified, lumbar region M46.47 Discitis, unspecified, lumbosacral region M46.95 Unspecified inflammatory spondylopathy, thoracolumbar region M46.96 Unspecified inflammatory spondylopathy, lumbar region M46.97 Unspecified inflammatory spondylopathy, lumbosacral region M47.16 Other spondylosis with myelopathy, lumbar region M47.26 Other spondylosis with radiculopathy, lumbar region M47.27 Other spondylosis with radiculopathy, lumbosacral region M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region M47.896 Other spondylosis, lumbar region M47.897 Other spondylosis, lumbosacral region M48.061 Spinal stenosis, lumbar region without neurogenic claudication
M48.062 Spinal stenosis, lumbar region with neurogenic claudication
M48.07 Spinal stenosis, lumbosacral region

M48.35 Traumatic spondylopathy, thoracolumbar region M48.36 Traumatic spondylopathy, lumbar region M48.37 Traumatic spondylopathy, lumbosacral region 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 M48.55XA Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture M48.56XA Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture M48.57XA Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture M48.8X5 Other specified spondylopathies, thoracolumbar region M48.8X6 Other specified spondylopathies, lumbar region M48.8X7 Other specified spondylopathies, lumbosacral region M51.05 Intervertebral disc disorders with myelopathy, thoracolumbar region M51.06 Intervertebral disc disorders with myelopathy, lumbar region M51.16 Intervertebral disc disorders with radiculopathy, lumbar region M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region M51.26 Other intervertebral disc displacement, lumbar region M51.27 Other intervertebral disc displacement, lumbosacral region M51.35 Other intervertebral disc degeneration, thoracolumbar region M51.36 Other intervertebral disc degeneration, lumbar region M51.360 Other intervertebral disc degeneration, lumbar region with discogenic back pain only M51.361 Other intervertebral disc degeneration, lumbar region with lower extremity pain only M51.362 Other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain M51.369 Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain M51.370 Other intervertebral disc degeneration, lumbosacralregion with discogenic back pain onl M51.371 Other intervertebral disc degeneration, lumbosacralregion with lower extremity pain only M51.372 Other intervertebral disc degeneration, lumbosacralregion with discogenic back pain and lower extremity pain M51.379 Other intervertebral disc degeneration, lumbosacralregion without mention of lumbar back pain or lower extremity pain M51.86 Other intervertebral disc disorders, lumbar region M51.87 Other intervertebral disc disorders, lumbosacral region M51.9 Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder M54.15 Radiculopathy, thoracolumbar region M54.16 Radiculopathy, lumbar region M54.17 Radiculopathy, lumbosacral region M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture M80.08XK Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion

M80.80XP Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion M84.58XA Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture (Vertebrae)
M96.1 Postlaminectomy syndrome, not elsewhere classified M99.13 Subluxation complex (vertebral) of lumbar region M99.23 Subluxation stenosis of neural canal of lumbar region M99.33 Osseous stenosis of neural canal of lumbar region M99.43 Connective tissue stenosis of neural canal of lumbar region M99.53 Intervertebral disc stenosis of neural canal of lumbar region M99.63 Osseous and subluxation stenosis of intervertebral foramina of lumbar region M99.73 Connective tissue and disc stenosis of intervertebral foramina of lumbar region M99.83 Other biomechanical lesions of lumbar region Q76.2 Congenital spondylolisthesis Q76.3 Congenital scoliosis due to congenital bony malformation Q76.415 Congenital kyphosis, thoracolumbar region S32.000A Wedge compression fracture of unspecified lumbar vertebra, initial encounter for closed fracture S32.000B Wedge compression fracture of unspecified lumbar vertebra, initial encounter for open fracture S32.001A Stable burst fracture of unspecified lumbar vertebra, initial encounter for closed fracture S32.001B Stable burst fracture of unspecified lumbar vertebra, initial encounter for open fracture S32.002A Unstable burst fracture of unspecified lumbar vertebra, initial encounter for closed fracture S32.002B Unstable burst fracture of unspecified lumbar vertebra, initial encounter for open fracture S32.008A Other fracture of unspecified lumbar vertebra, initial encounter for closed fracture S32.008B Other fracture of unspecified lumbar vertebra, initial encounter for open fracture S32.009A Unspecified fracture of unspecified lumbar vertebra, initial encounter for closed fracture S32.009B Unspecified fracture of unspecified lumbar vertebra, initial encounter for open fracture S32.010A Wedge compression fracture of first lumbar vertebra, initial encounter for closed fracture S32.010B Wedge compression fracture of first lumbar vertebra, initial encounter for open fracture S32.011A Stable burst fracture of first lumbar vertebra, initial encounter for closed fracture S32.011B Stable burst fracture of first lumbar vertebra, initial encounter for open fracture S32.012A Unstable burst fracture of first lumbar vertebra, initial encounter for closed fracture S32.012B Unstable burst fracture of first lumbar vertebra, initial encounter for open fracture S32.018A Other fracture of first lumbar vertebra, initial encounter for closed fracture S32.018B Other fracture of first lumbar vertebra, initial encounter for open fracture S32.019A Unspecified fracture of first lumbar vertebra, initial encounter for closed fracture S32.019B Unspecified fracture of first lumbar vertebra, initial encounter for open fracture S32.020A Wedge compression fracture of second lumbar vertebra, initial encounter for closed fracture S32.020B Wedge compression fracture of second lumbar vertebra, initial encounter for open fracture S32.021A Stable burst fracture of second lumbar vertebra, initial encounter for closed fracture

S32.021B Stable burst fracture of second lumbar vertebra, initial encounter for open fracture S32.022A Unstable burst fracture of second lumbar vertebra, initial encounter for closed fracture S32.022B Unstable burst fracture of second lumbar vertebra, initial encounter for open fracture S32.028A Other fracture of second lumbar vertebra, initial encounter for closed fracture S32.028B Other fracture of second lumbar vertebra, initial encounter for open fracture S32.029A Unspecified fracture of second lumbar vertebra, initial encounter for closed fracture S32.029B Unspecified fracture of second lumbar vertebra, initial encounter for open fracture S32.030A Wedge compression fracture of third lumbar vertebra, initial encounter for closed fracture S32.030B Wedge compression fracture of third lumbar vertebra, initial encounter for open fracture S32.031A Stable burst fracture of third lumbar vertebra, initial encounter for closed fracture S32.031B Stable burst fracture of third lumbar vertebra, initial encounter for open fracture S32.032A Unstable burst fracture of third lumbar vertebra, initial encounter for closed fracture S32.032B Unstable burst fracture of third lumbar vertebra, initial encounter for open fracture S32.038A Other fracture of third lumbar vertebra, initial encounter for closed fracture S32.038B Other fracture of third lumbar vertebra, initial encounter for open fracture S32.039A Unspecified fracture of third lumbar vertebra, initial encounter for closed fracture S32.039B Unspecified fracture of third lumbar vertebra, initial encounter for open fracture S32.040A Wedge compression fracture of fourth lumbar vertebra, initial encounter for closed fracture S32.040B Wedge compression fracture of fourth lumbar vertebra, initial encounter for open fracture S32.041A Stable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture S32.041B Stable burst fracture of fourth lumbar vertebra, initial encounter for open fracture S32.042A Unstable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture S32.042B Unstable burst fracture of fourth lumbar vertebra, initial encounter for open fracture S32.048A Other fracture of fourth lumbar vertebra, initial encounter for closed fracture S32.048B Other fracture of fourth lumbar vertebra, initial encounter for open fracture S32.049A Unspecified fracture of fourth lumbar vertebra, initial encounter for closed fracture S32.049B Unspecified fracture of fourth lumbar vertebra, initial encounter for open fracture S32.050A Wedge compression fracture of fifth lumbar vertebra, initial encounter for closed fracture S32.050B Wedge compression fracture of fifth lumbar vertebra, initial encounter for open fracture S32.051A Stable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture S32.051B Stable burst fracture of fifth lumbar vertebra, initial encounter for open fracture S32.052A Unstable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture S32.052B Unstable burst fracture of fifth lumbar vertebra, initial encounter for open fracture S32.058A Other fracture of fifth lumbar vertebra, initial encounter for closed fracture S32.058B Other fracture of fifth lumbar vertebra, initial encounter for open fracture S32.059A Unspecified fracture of fifth lumbar vertebra, initial encounter for closed fracture S32.059B Unspecified fracture of fifth lumbar vertebra, initial encounter for open fracture S32.9xxK Fracture of unspecified parts of lumbosacral spine and pelvis, subsequent encounter for fracture with nonunion

S33.0xxA Traumatic rupture of lumbar intervertebral disc, initial encounter S33.100A Subluxation of unspecified lumbar vertebra, initial encounter S33.101A Dislocation of unspecified lumbar vertebra, initial encounter S33.110A Subluxation of L1/L2 lumbar vertebra, initial encounter S33.111A Dislocation of L1/L2 lumbar vertebra, initial encounter S33.120A Subluxation of L2/L3 lumbar vertebra, initial encounter S33.121A Dislocation of L2/L3 lumbar vertebra, initial encounter S33.130A Subluxation of L3/L4 lumbar vertebra, initial encounter S33.131A Dislocation of L3/L4 lumbar vertebra, initial encounter S33.140A Subluxation of L4/L5 lumbar vertebra, initial encounter S33.141A Dislocation of L4/L5 lumbar vertebra, initial encounter

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Specialty matched clinical peer review.