Head MRA/MRV studies of the head may be considered medically necessary for the following strongly suspected vascular diseases:

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1 Original Issue Date (Created): July 1, 2002 Most Recent Review Date (Revised): January 28, 2014 Effective Date: September 5, 2014 I. POLICY Head MRA/MRV studies of the head may be considered medically necessary for the following strongly suspected vascular diseases: Cerebral aneurysm; Cerebral sinus compression; In combination with MRI of the brain, for evaluation of new onset cerebral ischemic symptoms, where data from brain MRA would affect and modify planned treatment in the immediate setting. Intracranial vascular malformations; May be ordered separately to rule out aneurysm in patients with a family history of cerebral aneurysm; Pulsatile tinnitus To evaluate steno-occlusive disease for mid/large size intracranial arteries, when intracranial angioplasty is being considered. NOTE: A MRA/MRV should not be ordered in conjunction with an MRI unless there is evidence from a previous examination that an abnormality is present or with acute onset cerebral ischemia, and the course of therapy will be changed by the results. Neck MRA/MRV studies of the neck may be considered medically necessary only after recent abnormal carotid Doppler for the following indications: Cervicocranial arterial dissection; For carotid body tumors (i.e., glomus tumor); For post-operative evaluation of carotid endarterectomy (arterial neck surgery) when it replaces catheter angiography if there are newly presenting symptoms; For the evaluation of cerebral ischemia symptoms; For the evaluation of vertebral disease; For the evaluation of posterior circulation which is not detected by carotid Doppler Suspected carotid stenosis. NOTE: Repeat MRA/MRV studies are considered duplicative unless there has been a significant change in the patient s condition. Page 1

2 Chest MRA/MRV studies of the chest may be considered medically necessary for the following indications: As an alternative to angiography for evaluation of pulmonary embolus in patients who cannot have iodinated contrast material; For acquired disease of the thoracic aorta; For developmental anomaly of the thoracic vasculature; For evaluation of aortic aneurysms, including the dissecting type; For evaluation of congenital heart disease in children (rarely in adults); For systemic venous thrombosis or occlusion; To evaluate axillary, subclavian, or brachiocephalic vessel status as an alternative to catheter angiography when fast scan helical CT cannot be performed. Abdomen MRA/MRV studies of the abdomen may be considered medically necessary with specific signs or symptoms indicating the following indications: Abdominal aneurysm; Aortic aneurysm; Atherosclerotic renal artery disease; Chronic mesenteric ischemia; Documented uncontrolled hypertension; Evaluation of systemic venous system abnormalities; Evaluation of the portal venous system; (hepatic portal system); For patients with suspected atherosclerotic renal artery disease or stenosis; Kidney failure; Renal artery narrowing or hypertension; (NOTE: MRA studies of the abdomen for this indication do not also require combination MRI studies); Suspected renal vein clot in patients with known renal mass. NOTE: A non-specific abdominal mass should be evaluated first with ultrasound, CT scan or MRI. Inferior vena cava thrombosis usually should have a Doppler venous study of the lower extremities first. Spinal Canal MRA/MRV studies of the spinal canal may be considered medically necessary for the following indications: For evaluation of arteriovenous malformation (AVM) and dural AV fistulae; For the evaluation of a cervical spine ; For the evaluation and/or suspicion of a vertebral artery injury Page 2

3 Pelvis MRA/MRV studies of the pelvis may be considered medically necessary for the following indications: For pre/post therapy evaluation for ectopic pregnancy For the evaluation of a complex vascular lesion in the pelvis; For the evaluation of a renal transplant to evaluate vascular integrity; For the evaluation of deep venous thrombosis (DVT) of the leg when a Doppler study is inconclusive; Imaging the renal arteries and the aortoiliac arteries in the absence of AAA or aortic dissection Pre-operative evaluation of abdominal aortic aneurysm (AAA) repair Upper Extremity MRA/MRV of the upper extremities may be considered medically necessary for the following indications: To determine major vessel patency in the preoperative evaluation of patients who are candidates for upper extremity reconstructive surgery or sympathectomy; To evaluate severe ischemic disease of the upper extremities; To evaluate patients with suspected glomus tumor of the upper extremity; To evaluate upper extremity embolism, aneurysms, and arteriovenous fistula; Lower Extremity MRA/MRV studies of the lower extremity may be considered medically necessary for the following indications: For the usual leg study or runoff, performed instead of arteriography with specific signs or symptoms of ischemia, foot ulcer, claudication, or other peripheral vascular disease; To delineate occult/collateral vessels. NOTE: For lower extremity thrombophlebitis, usually a Doppler venous study should be performed instead of lower extremity MRA/MRV studies. MRA/MRV studies for diagnoses or conditions not listed above are considered not medically necessary. Cardiovascular magnetic resonance imaging for velocity flow mapping is considered investigational. MRA/MRV is considered investigational in the evaluation of potential renal donors for the presence of accessory renal arteries. There is insufficient evidence to support a conclusion concerning the health outcomes or benefits associated with the above investigational procedures. Page 3

4 II. PRODUCT VARIATIONS [N] = No product variation, policy applies as stated [Y] = Standard product coverage varies from application of this policy, see below [N] Capital Cares 4 Kids [N] PPO [N] HMO [Y] SeniorBlue HMO* [Y] SeniorBlue PPO* [N] Indemnity [N] SpecialCare [N] POS [Y] FEP PPO** *Refer to Novitas Solutions Local Coverage Determination (LCD) L31399 Magnetic Resonance Angiography (MRA) for additional indications. *Effective for claims with dates of service on or after February 24, 201l, Medicare will provide coverage for MRIs for beneficiaries with implanted cardiac pacemakers or implantable cardioverter defibrillators if the beneficiary is enrolled in an approved clinical study under the Coverage with Study Participation form of Coverage with Evidence Development that meets specific criteria per Pub , the NCD Manual, chapter 1, section C.1. ** Refer to FEP Medical Policy Manual MP Magnetic Resonance Angiography of Vessels of the Head, Neck, Abdomen, Pelvis, and Lower Extremity for these specific indications. The FEP Medical Policy manual can be found at: III. DESCRIPTION/BACKGROUND Magnetic resonance angiography (MRA) is a variation of magnetic resonance imaging (MRI). MR vascular imaging may include the IV injection of MR specific contrast agents to optimize visualization of certain vascular anatomy. MRA is a general term that is used to describe magnetic resonance (MR) imaging of vascular structures. When MR is used to image a vein instead of an artery, the term, "magnetic resonance venography" (MRV) may be used. MRA is used to evaluate medium and large size vessels and is a non-invasive alternative to standard angiography. MRA can be performed on MRI scanners that have the appropriate hardware and software configuration. IV. DEFINITIONS ANGIOGRAPHY refers to diagnostic images produced by x-rays of the heart and blood vessels using a radiopaque contrast medium. Page 4

5 MAGNETIC RESONANCE IMAGING is a type of diagnostic radiography that uses the characteristic behavior of protons (and other atomic nuclei) when placed in powerful magnetic fields to make images of tissues and organs. V. BENEFIT VARIATIONS The existence of this medical policy does not mean that this service is a covered benefit under the member's contract. Benefit determinations should be based in all cases on the applicable contract language. Medical policies do not constitute a description of benefits. A member s individual or group customer benefits govern which services are covered, which are excluded, and which are subject to benefit limits and which require preauthorization. Members and providers should consult the member s benefit information or contact Capital for benefit information. VI. DISCLAIMER Capital s medical policies are developed to assist in administering a member s benefits, do not constitute medical advice and are subject to change. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any medical policy related to their coverage or condition with their provider and consult their benefit information to determine if the service is covered. If there is a discrepancy between this medical policy and a member s benefit information, the benefit information will govern. Capital considers the information contained in this medical policy to be proprietary and it may only be disseminated as permitted by law. VII. REFERENCES American College of Radiology. ACR Appropriateness Criteria. MRA (Index). [Website]: Accessed February 13, BCBSA TEC Assessments 1996: Tab 31. BCBSA TEC Assessments 1996: Tab 32. BCBSA TEC Assessments 1997: Tab 1. BCBSA TEC Assessment 1997; Tab 10, MRA of the Chest-part III: Systemic Venous Thrombosis of Occlusion. BCBSA TEC Assessment 1997; Tab 8, MRA of the Chest-part I: Acquired Disease of the Thoracic Aorta. BCBSA TEC Assessment 1997; Tab 9, MRA of the Chest-part II: Developmental Anomalies of the Thoracic Vasculature. BCBSA TEC Assessment1997; Tab 11, MRA of the Chest-part IV: Pulmonary Embolism. Centers for Medicare and Medicaid Services (CMS) Manual System, Pub Chapter 13- Radiology Services and Other Diagnostic Procedures. Effective , Medicare Claims Page 5

6 Processing. CMS Website: Accessed October 17, Centers for Medicare and Medicaid Services (CMS) National Coverage Determination (NCD) Magnetic Resonance Imaging. Effective 9/26/11. CMS [Website]: Accessed October 17, Michaely HJ, Attenberger UI, Kramer H, et al. Abdominal and pelvic MR angiography. Magn Reson Imaging Clin N Am Aug; 15(3):301-14, v-vi. Muhs BE, Verhagen HJ, Huddle MG, et al. Theory, technique, and practice of magnetic resonance angiography. Vascular Nov-Dec; 15(6): Novitas Solutions Inc. Local Coverage Determination (LCD) L31399: Magnetic Resonance Angiography. Effective 04/02/12. [Website]: Accessed October 17, Taber's Cyclopedic Medical Dictionary, 19th edition. Tierney L, McPhee S, Padadakis M. Current Medical Diagnosis and Treatment (40 th Edition). New York: Lange Medical Books/Mcgraw-Hill, p Zhang H, Maki JH, Prince MR. 3D contrast-enhanced MR angiography. J Magn Reson Imaging Jan; 25(1): VIII. CODING INFORMATION Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement. Covered when medically necessary: CPT Codes Current Procedural Terminology (CPT) copyrighted by American Medical Association. All Rights Reserved. HCPCS Code C8900 C8901 C8902 C8909 C8910 MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDOMEN MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, ABDOMEN MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, ABDOMEN MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM) MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, CHEST (EXCLUDING MYOCARDIUM) Page 6

7 HCPCS Code C8911 C8912 C8913 C8914 C8918 C8919 C8920 MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM) MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, LOWER EXTREMITY MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, LOWER EXTREMITY MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, LOWER EXTREMITY MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, PELVIS MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, PELVIS MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, PELVIS ICD-10- Procedure codes Arteriography of cerebral arteries (includes MRA of head, neck, and spine) Arteriography of other intrathoracic vessels Arteriography of intra-abdominal arteries (includes MRA of abdomen) ICD-9-CM Diagnosis SYPHILITIC RUPTURE OF CEREBRAL ANEURYSM BENIGN NEOPLASM OF CAROTID BODY UNSPECIFIED TINNITUS MALIGNANT HYPERTENSION IATROGENIC PULMONARY EMBOLISM AND INFARCTION SEPTIC PULMONARY EMBOLISM OTHER PULMONARY EMBOLISM AND INFARCTION 430. SUBARACHNOID HEMORRHAGE OCCLUSION AND STENOSIS OF BASILAR ARTERY OCCLUSION AND STENOSIS OF CAROTID ARTERY WITH CEREBRAL INFARCTION CEREBRAL THROMBOSIS WITHOUT MENTION OF CEREBRAL INFARCTION Page 7

8 ICD-9-CM Diagnosis CEREBRAL ATHEROSCLEROSIS ATHEROSCLEROSIS OF RENAL ARTERY DISSECTION OF AORTA DISSECTING AORTIC ANEURYSM (ANY PART), THORACIC ANEURYSM OF OTHER SPECIFIED ARTERY DISSECTION OF CAROTID ARTERY EMBOLISM AND THROMBOSIS OF ARTERIES OF UPPER EXTREMITY ARTERIOVENOUS FISTULA, ACQUIRED UNSPECIFIED ARTERITIS UNSPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES 452. PORTAL VEIN THROMBOSIS 453. OTHER VENOUS EMBOLISM AND THROMBOSIS EMBOLISM AND THROMBOSIS OF RENAL VEIN ACUTE VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VEINS OF UPPER EXTREMITY ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VEINS OF UPPER EXTREMITY ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY, UNSPECIFIED EMBOLISM AND THROMBOSIS OF UNSPECIFIED SITE COMPRESSION OF VEIN ACUTE VASCULAR INSUFFICIENCY OF INTESTINE CHRONIC VASCULAR INSUFFICIENCY OF INTESTINE UNSPECIFIED VASCULAR INSUFFICIENCY OF INTESTINE 571. CHRONIC LIVER DISEASE AND CIRRHOSIS ACUTE KIDNEY FAILURE CHRONIC KIDNEY DISEASE (CKD) OTHER ECTOPIC PREGNANCY WITHOUT INTRAUTERINE PREGNANCY OTHER ECTOPIC PREGNANCY WITH INTRAUTERINE PREGNANCY UNSPECIFIED ECTOPIC PREGNANCY WITHOUT INTRAUTERINE PREGNANCY UNSPECIFIED ECTOPIC PREGNANCY WITH INTRAUTERINE PREGNANCY CONGENITAL OBSTRUCTIVE ANOMALIES OF HEART, NOT ELSEWHERE CLASSIFIED UNSPECIFIED CONGENITAL ANOMALY OF HEART OTHER CONGENITAL ANOMALIES OF GREAT VEINS CONGENITAL ANOMALY OF THE PERIPHERAL VASCULAR SYSTEM, UNSPECIFIED SITE OTHER SPECIFIED CONGENITAL ANOMALIES OF CIRCULATORY SYSTEM CONGENITAL ANOMALY OF CEREBROVASCULAR SYSTEM Page 8

9 ICD-9-CM Diagnosis OTHER SPECIFIED CONGENITAL ANOMALY OF CIRCULATORY SYSTEM OTHER SPECIFIED MULTIPLE CONGENITAL ANOMALIES, SO DESCRIBED FRACTURE OF VERTEBRAL COLUMN WITHOUT MENTION OF SPINAL CORD INJURY CERVICAL OPEN CLOSED FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT MENTION OF SPINAL CORD INJURY OPEN FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT MENTION OF SPINAL CORD INJURY CLOSED FRACTURE OF LUMBAR VERTEBRA WITHOUT MENTION OF SPINAL CORD INJURY OPEN FRACTURE OF LUMBAR VERTEBRA WITHOUT MENTION OF SPINAL CORD INJURY CLOSED FRACTURE OF SACRUM AND COCCYX WITHOUT MENTION OF SPINAL CORD INJURY OPEN FRACTURE OF SACRUM AND COCCYX WITHOUT MENTION OF SPINAL CORD INJURY CLOSED FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT MENTION OF SPINAL CORD INJURY OPEN FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT MENTION OF SPINAL CORD INJURY CLOSED FRACTURE OF CERVICAL VERTEBRA WITH SPINAL CORD INJURY CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF CERVICAL VERTEBRA WITH SPINAL CORD INJURY INTRACRANIAL INJURY OF OTHER AND UNSPECIFIED NATURE WITHOUT MENTION OF OPEN INTRACRANIAL WOUND *If applicable, please see Medicare LCD or NCD for additional covered diagnoses. The following ICD-10 diagnosis codes will be effective October 1, 2014 Diagnosis D35.5 Benign neoplasm of carotid body E78.71 Barth syndrome E78.72 Smith-Lemli-Opitz syndrome G45.1 Carotid artery syndrome (hemispheric) G45.2 Multiple and bilateral precerebral artery syndromes G45.8 Other transient cerebral ischemic attacks and related syndromes G45.9 Transient cerebral ischemic attack, unspecified G46.0 Middle cerebral artery syndrome Page 9

10 Diagnosis G46.1 Anterior cerebral artery syndrome G46.2 Posterior cerebral artery syndrome H93.11 Tinnitus, right ear H93.12 Tinnitus, left ear H93.13 Tinnitus, bilateral H93.19 Tinnitus, unspecified ear I10 Essential (primary) hypertension I26.01 Septic pulmonary embolism with acute cor pulmonale I26.09 Other pulmonary embolism with acute cor pulmonale I26.90 Septic pulmonary embolism without acute cor pulmonale I26.99 Other pulmonary embolism without acute cor pulmonale I60.00 Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation I60.10 Nontraumatic subarachnoid hemorrhage from unspecified middle cerebral artery I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery I60.20 Nontraumatic subarachnoid hemorrhage from unspecified anterior communicating artery I60.21 Nontraumatic subarachnoid hemorrhage from right anterior communicating artery I60.22 Nontraumatic subarachnoid hemorrhage from left anterior communicating artery I60.30 Nontraumatic subarachnoid hemorrhage from unspecified posterior communicating artery I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery I60.50 Nontraumatic subarachnoid hemorrhage from unspecified vertebral artery I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries I60.7 Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery I60.8 Other nontraumatic subarachnoid hemorrhage I60.9 Nontraumatic subarachnoid hemorrhage, unspecified I Cerebral infarction due to thrombosis of right carotid artery I Cerebral infarction due to thrombosis of left carotid artery I Cerebral infarction due to thrombosis of unspecified carotid artery I Cerebral infarction due to embolism of right carotid artery I Cerebral infarction due to embolism of left carotid artery Page 10

11 Diagnosis I Cerebral infarction due to embolism of unspecified carotid artery I Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries I Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries I Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid arteries I65.1 Occlusion and stenosis of basilar artery I66.01 Occlusion and stenosis of right middle cerebral artery I66.02 Occlusion and stenosis of left middle cerebral artery I66.03 Occlusion and stenosis of bilateral middle cerebral arteries I66.09 Occlusion and stenosis of unspecified middle cerebral artery I66.11 Occlusion and stenosis of right anterior cerebral artery I66.12 Occlusion and stenosis of left anterior cerebral artery I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries I66.19 Occlusion and stenosis of unspecified anterior cerebral artery I66.21 Occlusion and stenosis of right posterior cerebral artery I66.22 Occlusion and stenosis of left posterior cerebral artery I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries I66.29 Occlusion and stenosis of unspecified posterior cerebral artery I66.3 Occlusion and stenosis of cerebellar arteries I67.1 Cerebral aneurysm, nonruptured I67.2 Cerebral atherosclerosis I70.1 Atherosclerosis of renal artery I71.00 Dissection of unspecified site of aorta I71.01 Dissection of thoracic aorta I72.8 Aneurysm of other specified arteries I74.2 Embolism and thrombosis of arteries of the upper extremities I77.0 Arteriovenous fistula, acquired I77.6 Arteritis, unspecified I77.9 Disorder of arteries and arterioles, unspecified I81 Portal vein thrombosis I82.0 Budd-Chiari syndrome I82.3 Embolism and thrombosis of renal vein I Acute embolism and thrombosis of unspecified veins of right upper extremity I Acute embolism and thrombosis of unspecified veins of left upper extremity I Acute embolism and thrombosis of unspecified veins of upper extremity, bilateral I Acute embolism and thrombosis of unspecified veins of unspecified upper extremity I Acute embolism and thrombosis of superficial veins of right upper extremity Page 11

12 Diagnosis I Acute embolism and thrombosis of superficial veins of left upper extremity I Acute embolism and thrombosis of superficial veins of upper extremity, bilateral I Acute embolism and thrombosis of superficial veins of unspecified upper extremity I Acute embolism and thrombosis of deep veins of right upper extremity I Acute embolism and thrombosis of deep veins of left upper extremity I Acute embolism and thrombosis of deep veins of upper extremity, bilateral I Acute embolism and thrombosis of deep veins of unspecified upper extremity I82.91 Chronic embolism and thrombosis of unspecified vein I87.1 Compression of vein K55.0 Acute vascular disorders of intestine K55.1 Chronic vascular disorders of intestine K55.8 Other vascular disorders of intestine K55.9 Vascular disorder of intestine, unspecified K70.0 Alcoholic fatty liver N17.0 Acute kidney failure with tubular necrosis N17.1 Acute kidney failure with acute cortical necrosis N17.2 Acute kidney failure with medullary necrosis N17.8 Other acute kidney failure N17.9 Acute kidney failure, unspecified N18.1 Chronic kidney disease, stage 1 N18.2 Chronic kidney disease, stage 2 (mild) N18.3 Chronic kidney disease, stage 3 (moderate) N18.4 Chronic kidney disease, stage 4 (severe) N18.5 Chronic kidney disease, stage 5 N18.6 End stage renal disease N18.9 Chronic kidney disease, unspecified O00.8 Other ectopic pregnancy O00.9 Ectopic pregnancy, unspecified Q20.9 Congenital malformation of cardiac chambers and connections, unspecified Q24.8 Other specified congenital malformations of heart Q24.9 Congenital malformation of heart, unspecified Q26.0 Congenital stenosis of vena cava Q26.1 Persistent left superior vena cava Q26.8 Other congenital malformations of great veins Q27.30 Arteriovenous malformation, site unspecified Q27.4 Congenital phlebectasia Page 12

13 Diagnosis Q27.9 Congenital malformation of peripheral vascular system, unspecified Q28.0 Arteriovenous malformation of precerebral vessels Q28.1 Other malformations of precerebral vessels Q28.2 Arteriovenous malformation of cerebral vessels Q28.3 Other malformations of cerebral vessels Q28.8 Other specified congenital malformations of circulatory system Q87.2 Congenital malformation syndromes predominantly involving limbs Q87.3 Congenital malformation syndromes involving early overgrowth Q87.5 Other congenital malformation syndromes with other skeletal changes Q87.81 Alport syndrome Q87.89 Other specified congenital malformation syndromes, not elsewhere classified Q89.8 Other specified congenital malformations S06.0x0a S06.1x0a S06.1x1a S06.1x2a S06.1x3a S06.1x4a S06.1x5a S06.1x6a S06.1x7a S06.1x8a S06.1x9a S06.2x0a S06.2x1a S06.2x2a S06.2x3a S06.2x4a S06.2x5a S06.2x6a S06.2x7a Concussion without loss of consciousness, initial Traumatic cerebral edema without loss of consciousness, initial Traumatic cerebral edema with loss of consciousness of 30 minutes or less, initial Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, initial Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, initial Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to preexisting conscious level with patient surviving, initial Traumatic cerebral edema with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial Traumatic cerebral edema with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial Traumatic cerebral edema with loss of consciousness of unspecified duration, initial Diffuse traumatic brain injury without loss of consciousness, initial Diffuse traumatic brain injury with loss of consciousness of 30 minutes or less, initial Diffuse traumatic brain injury with loss of consciousness of 31 minutes to 59 minutes, initial Diffuse traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial Diffuse traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial Diffuse traumatic brain injury with loss of consciousness greater than 24 hours with return to preexisting conscious levels., initial Diffuse traumatic brain injury with loss of consciousness greater than 24 hours without return to preexisting conscious level with patient surviving, initial Diffuse traumatic brain injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial Page 13

14 Diagnosis S06.2x8a S06.2x9a S06.300a S06.301a S06.302a S06.303a S06.304a S06.305a S06.306a S06.307a S06.308a S06.309a S06.810a S06.811a S06.812a S06.813a S06.814a S06.815a S06.816a S06.817a S06.818a S06.819a Diffuse traumatic brain injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial Diffuse traumatic brain injury with loss of consciousness of unspecified duration, initial Unspecified focal traumatic brain injury without loss of consciousness, initial Unspecified focal traumatic brain injury with loss of consciousness of 30 minutes or less, initial Unspecified focal traumatic brain injury with loss of consciousness of 31 minutes to 59 minutes, initial Unspecified focal traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial Unspecified focal traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial Unspecified focal traumatic brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial Unspecified focal traumatic brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial Unspecified focal traumatic brain injury with loss of consciousness of unspecified duration, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified without loss of consciousness, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 30 minutes or less, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of unspecified duration, initial Page 14

15 Diagnosis S06.820a S06.821a S06.822a S06.823a S06.824a S06.825a S06.826a S06.827a S06.828a S06.829a S06.890a S06.891a S06.892a S06.893a S06.894a S06.895a S06.896a S06.897a S06.898a S06.899a S06.9x0a S06.9x1a S06.9x2a S06.9x3a Injury of left internal carotid artery, intracranial portion, not elsewhere classified without loss of consciousness, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 30 minutes or less, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of unspecified duration, initial Other specified intracranial injury without loss of consciousness, initial Other specified intracranial injury with loss of consciousness of 30 minutes or less, initial Other specified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, initial Other specified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial Other specified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial Other specified intracranial injury with loss of consciousness greater than 24 hours with return to preexisting conscious level, initial Other specified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial Other specified intracranial injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial Other specified intracranial injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial Other specified intracranial injury with loss of consciousness of unspecified duration, initial Unspecified intracranial injury without loss of consciousness, initial Unspecified intracranial injury with loss of consciousness of 30 minutes or less, initial Unspecified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, initial Unspecified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial Page 15

16 Diagnosis S06.9x4a S06.9x5a S06.9x6a S06.9x7a S06.9x9a S06.890a S12.000a S12.000b S12.001a S12.001b S12.01xa S12.01xb S12.02xa S12.02xb S12.030a S12.030b S12.031a S12.031b S12.040a S12.040b S12.041a S12.041b S12.090a S12.090b S12.091a S12.091b S12.100a S12.100b S12.101a S12.101b S12.110a S12.110b S12.111a S12.111b S12.112a Unspecified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial Unspecified intracranial injury with loss of consciousness greater than 24 hours with return to preexisting conscious level, initial Unspecified intracranial injury with loss of consciousness greater than 24 hours without return to preexisting conscious level with patient surviving, initial Unspecified intracranial injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial Unspecified intracranial injury with loss of consciousness of unspecified duration, initial Other specified intracranial injury without loss of consciousness, initial Unspecified displaced of first cervical vertebra, initial for closed Unspecified displaced of first cervical vertebra, initial for open Unspecified nondisplaced of first cervical vertebra, initial for closed Unspecified nondisplaced of first cervical vertebra, initial for open Stable burst of first cervical vertebra, initial for closed Stable burst of first cervical vertebra, initial for open Unstable burst of first cervical vertebra, initial for closed Unstable burst of first cervical vertebra, initial for open Displaced posterior arch of first cervical vertebra, initial for closed Displaced posterior arch of first cervical vertebra, initial for open Nondisplaced posterior arch of first cervical vertebra, initial for closed Nondisplaced posterior arch of first cervical vertebra, initial for open Displaced lateral mass of first cervical vertebra, initial for closed Displaced lateral mass of first cervical vertebra, initial for open Nondisplaced lateral mass of first cervical vertebra, initial for closed Nondisplaced lateral mass of first cervical vertebra, initial for open Other displaced of first cervical vertebra, initial for closed Other displaced of first cervical vertebra, initial for open Other nondisplaced of first cervical vertebra, initial for closed Other nondisplaced of first cervical vertebra, initial for open Unspecified displaced of second cervical vertebra, initial for closed Unspecified displaced of second cervical vertebra, initial for open Unspecified nondisplaced of second cervical vertebra, initial for closed Unspecified nondisplaced of second cervical vertebra, initial for open Anterior displaced Type II dens, initial for closed Anterior displaced Type II dens, initial for open Posterior displaced Type II dens, initial for closed Posterior displaced Type II dens, initial for open Nondisplaced Type II dens, initial for closed Page 16

17 Diagnosis S12.112b S12.120a S12.120b S12.121a S12.121b S12.130a S12.130b S12.131a S12.131b S12.14xa S12.14xb S12.150a S12.150b S12.151a S12.151b S12.190a S12.190b S12.191a S12.191b S12.200a S12.200b S12.201a S12.201b S12.230a S12.230b S12.231a S12.231b S12.24xa S12.24xb Nondisplaced Type II dens, initial for open Other displaced dens, initial for closed Other displaced dens, initial for open Other nondisplaced dens, initial for closed Other nondisplaced dens, initial for open Unspecified traumatic displaced spondylolisthesis of second cervical vertebra, initial for closed Unspecified traumatic displaced spondylolisthesis of second cervical vertebra, initial for open Unspecified traumatic nondisplaced spondylolisthesis of second cervical vertebra, initial for closed Unspecified traumatic nondisplaced spondylolisthesis of second cervical vertebra, initial for open Type III traumatic spondylolisthesis of second cervical vertebra, initial for closed Type III traumatic spondylolisthesis of second cervical vertebra, initial for open Other traumatic displaced spondylolisthesis of second cervical vertebra, initial for closed Other traumatic displaced spondylolisthesis of second cervical vertebra, initial for open Other traumatic nondisplaced spondylolisthesis of second cervical vertebra, initial for closed Other traumatic nondisplaced spondylolisthesis of second cervical vertebra, initial for open Other displaced of second cervical vertebra, initial for closed Other displaced of second cervical vertebra, initial for open Other nondisplaced of second cervical vertebra, initial for closed Other nondisplaced of second cervical vertebra, initial for open Unspecified displaced of third cervical vertebra, initial for closed Unspecified displaced of third cervical vertebra, initial for open Unspecified nondisplaced of third cervical vertebra, initial for closed Unspecified nondisplaced of third cervical vertebra, initial for open Unspecified traumatic displaced spondylolisthesis of third cervical vertebra, initial for closed Unspecified traumatic displaced spondylolisthesis of third cervical vertebra, initial for open Unspecified traumatic nondisplaced spondylolisthesis of third cervical vertebra, initial for closed Unspecified traumatic nondisplaced spondylolisthesis of third cervical vertebra, initial for open Type III traumatic spondylolisthesis of third cervical vertebra, initial for closed Type III traumatic spondylolisthesis of third cervical vertebra, initial for open Page 17

18 Diagnosis S12.250a S12.250b S12.251a S12.251b S12.290a S12.290b S12.291a S12.291b S12.300a S12.300b S12.301a S12.301b S12.330a S12.330b S12.331a S12.331b S12.34xa S12.34xb S12.350a S12.350b S12.351a S12.351b S12.390a S12.390b S12.391a S12.391b S12.400a S12.400b S12.401a S12.401b Other traumatic displaced spondylolisthesis of third cervical vertebra, initial for closed Other traumatic displaced spondylolisthesis of third cervical vertebra, initial for open Other traumatic nondisplaced spondylolisthesis of third cervical vertebra, initial for closed Other traumatic nondisplaced spondylolisthesis of third cervical vertebra, initial for open Other displaced of third cervical vertebra, initial for closed Other displaced of third cervical vertebra, initial for open Other nondisplaced of third cervical vertebra, initial for closed Other nondisplaced of third cervical vertebra, initial for open Unspecified displaced of fourth cervical vertebra, initial for closed Unspecified displaced of fourth cervical vertebra, initial for open Unspecified nondisplaced of fourth cervical vertebra, initial for closed Unspecified nondisplaced of fourth cervical vertebra, initial for open Unspecified traumatic displaced spondylolisthesis of fourth cervical vertebra, initial for closed Unspecified traumatic displaced spondylolisthesis of fourth cervical vertebra, initial for open Unspecified traumatic nondisplaced spondylolisthesis of fourth cervical vertebra, initial for closed Unspecified traumatic nondisplaced spondylolisthesis of fourth cervical vertebra, initial for open Type III traumatic spondylolisthesis of fourth cervical vertebra, initial for closed Type III traumatic spondylolisthesis of fourth cervical vertebra, initial for open Other traumatic displaced spondylolisthesis of fourth cervical vertebra, initial for closed Other traumatic displaced spondylolisthesis of fourth cervical vertebra, initial for open Other traumatic nondisplaced spondylolisthesis of fourth cervical vertebra, initial for closed Other traumatic nondisplaced spondylolisthesis of fourth cervical vertebra, initial for open Other displaced of fourth cervical vertebra, initial for closed Other displaced of fourth cervical vertebra, initial for open Other nondisplaced of fourth cervical vertebra, initial for closed Other nondisplaced of fourth cervical vertebra, initial for open Unspecified displaced of fifth cervical vertebra, initial for closed Unspecified displaced of fifth cervical vertebra, initial for open Unspecified nondisplaced of fifth cervical vertebra, initial for closed Unspecified nondisplaced of fifth cervical vertebra, initial for open Page 18

19 Diagnosis S12.430a S12.430b S12.431a S12.431b S12.44xa S12.44xb S12.450a S12.450b S12.451a S12.451b S12.490a S12.490b S12.491a S12.491b S12.500a S12.500b S12.501a S12.501b S12.530a S12.530b S12.531a S12.531b S12.54xa S12.54xb S12.550a S12.550b S12.551a Unspecified traumatic displaced spondylolisthesis of fifth cervical vertebra, initial for closed Unspecified traumatic displaced spondylolisthesis of fifth cervical vertebra, initial for open Unspecified traumatic nondisplaced spondylolisthesis of fifth cervical vertebra, initial for closed Unspecified traumatic nondisplaced spondylolisthesis of fifth cervical vertebra, initial for open Type III traumatic spondylolisthesis of fifth cervical vertebra, initial for closed Type III traumatic spondylolisthesis of fifth cervical vertebra, initial for open Other traumatic displaced spondylolisthesis of fifth cervical vertebra, initial for closed Other traumatic displaced spondylolisthesis of fifth cervical vertebra, initial for open Other traumatic nondisplaced spondylolisthesis of fifth cervical vertebra, initial for closed Other traumatic nondisplaced spondylolisthesis of fifth cervical vertebra, initial for open Other displaced of fifth cervical vertebra, initial for closed Other displaced of fifth cervical vertebra, initial for open Other nondisplaced of fifth cervical vertebra, initial for closed Other nondisplaced of fifth cervical vertebra, initial for open Unspecified displaced of sixth cervical vertebra, initial for closed Unspecified displaced of sixth cervical vertebra, initial for open Unspecified nondisplaced of sixth cervical vertebra, initial for closed Unspecified nondisplaced of sixth cervical vertebra, initial for open Unspecified traumatic displaced spondylolisthesis of sixth cervical vertebra, initial for closed Unspecified traumatic displaced spondylolisthesis of sixth cervical vertebra, initial for open Unspecified traumatic nondisplaced spondylolisthesis of sixth cervical vertebra, initial for closed Unspecified traumatic nondisplaced spondylolisthesis of sixth cervical vertebra, initial for open Type III traumatic spondylolisthesis of sixth cervical vertebra, initial for closed Type III traumatic spondylolisthesis of sixth cervical vertebra, initial for open Other traumatic displaced spondylolisthesis of sixth cervical vertebra, initial for closed Other traumatic displaced spondylolisthesis of sixth cervical vertebra, initial for open Other traumatic nondisplaced spondylolisthesis of sixth cervical vertebra, initial for closed Page 19

20 Diagnosis S12.551b S12.590a S12.590b S12.591a S12.591b S12.600a S12.600b S12.601a S12.601b S12.630a S12.630b S12.631a S12.631b S12.64xa S12.64xb S12.650a S12.650b S12.651a S12.651b S12.690a S12.690b S12.691a S12.691b S12.9xxa S14.101a S14.102a S14.103a S14.104a S22.000a S22.000b S22.001a Other traumatic nondisplaced spondylolisthesis of sixth cervical vertebra, initial for open Other displaced of sixth cervical vertebra, initial for closed Other displaced of sixth cervical vertebra, initial for open Other nondisplaced of sixth cervical vertebra, initial for closed Other nondisplaced of sixth cervical vertebra, initial for open Unspecified displaced of seventh cervical vertebra, initial for closed Unspecified displaced of seventh cervical vertebra, initial for open Unspecified nondisplaced of seventh cervical vertebra, initial for closed Unspecified nondisplaced of seventh cervical vertebra, initial for open Unspecified traumatic displaced spondylolisthesis of seventh cervical vertebra, initial for closed Unspecified traumatic displaced spondylolisthesis of seventh cervical vertebra, initial for open Unspecified traumatic nondisplaced spondylolisthesis of seventh cervical vertebra, initial for closed Unspecified traumatic nondisplaced spondylolisthesis of seventh cervical vertebra, initial for open Type III traumatic spondylolisthesis of seventh cervical vertebra, initial for closed Type III traumatic spondylolisthesis of seventh cervical vertebra, initial for open Other traumatic displaced spondylolisthesis of seventh cervical vertebra, initial for closed Other traumatic displaced spondylolisthesis of seventh cervical vertebra, initial for open Other traumatic nondisplaced spondylolisthesis of seventh cervical vertebra, initial for closed Other traumatic nondisplaced spondylolisthesis of seventh cervical vertebra, initial for open Other displaced of seventh cervical vertebra, initial for closed Other displaced of seventh cervical vertebra, initial for open Other nondisplaced of seventh cervical vertebra, initial for closed Other nondisplaced of seventh cervical vertebra, initial for open Fracture of neck, unspecified, initial Unspecified injury at C1 level of cervical spinal cord, initial Unspecified injury at C2 level of cervical spinal cord, initial Unspecified injury at C3 level of cervical spinal cord, initial Unspecified injury at C4 level of cervical spinal cord, initial Wedge compression of unspecified thoracic vertebra, initial for closed Wedge compression of unspecified thoracic vertebra, initial for open Stable burst of unspecified thoracic vertebra, initial for closed Page 20

21 Diagnosis S22.001b S22.002a S22.002b S22.008a S22.008b S22.009a S22.009b S22.010a S22.010b S22.011a S22.011b S22.012a S22.012b S22.018a S22.018b S22.019a S22.019b S22.020a S22.020b S22.021a S22.021b S22.022a S22.022b S22.028a S22.028b S22.029a S22.029b S22.030a S22.030b S22.031a S22.031b S22.032a S22.032b S22.038a S22.038b S22.039a Stable burst of unspecified thoracic vertebra, initial for open Unstable burst of unspecified thoracic vertebra, initial for closed Unstable burst of unspecified thoracic vertebra, initial for open Other of unspecified thoracic vertebra, initial for closed Other of unspecified thoracic vertebra, initial for open Unspecified of unspecified thoracic vertebra, initial for closed Unspecified of unspecified thoracic vertebra, initial for open Wedge compression of first thoracic vertebra, initial for closed Wedge compression of first thoracic vertebra, initial for open Stable burst of first thoracic vertebra, initial for closed Stable burst of first thoracic vertebra, initial for open Unstable burst of first thoracic vertebra, initial for closed Unstable burst of first thoracic vertebra, initial for open Other of first thoracic vertebra, initial for closed Other of first thoracic vertebra, initial for open Unspecified of first thoracic vertebra, initial for closed Unspecified of first thoracic vertebra, initial for open Wedge compression of second thoracic vertebra, initial for closed Wedge compression of second thoracic vertebra, initial for open Stable burst of second thoracic vertebra, initial for closed Stable burst of second thoracic vertebra, initial for open Unstable burst of second thoracic vertebra, initial for closed Unstable burst of second thoracic vertebra, initial for open Other of second thoracic vertebra, initial for closed Other of second thoracic vertebra, initial for open Unspecified of second thoracic vertebra, initial for closed Unspecified of second thoracic vertebra, initial for open Wedge compression of third thoracic vertebra, initial for closed Wedge compression of third thoracic vertebra, initial for open Stable burst of third thoracic vertebra, initial for closed Stable burst of third thoracic vertebra, initial for open Unstable burst of third thoracic vertebra, initial for closed Unstable burst of third thoracic vertebra, initial for open Other of third thoracic vertebra, initial for closed Other of third thoracic vertebra, initial for open Unspecified of third thoracic vertebra, initial for closed Page 21

22 Diagnosis S22.039b S22.040a S22.040b S22.041a S22.041b S22.042a S22.042b S22.048a S22.048b S22.049a S22.049b S22.050a S22.050b S22.051a S22.051b S22.052a S22.052b S22.058a S22.058b S22.059a S22.059b S22.060a S22.060b S22.061a S22.061b S22.062a S22.062b S22.068a S22.068b S22.069a S22.069b S22.070a S22.070b S22.071a S22.071b S22.072a Unspecified of third thoracic vertebra, initial for open Wedge compression of fourth thoracic vertebra, initial for closed Wedge compression of fourth thoracic vertebra, initial for open Stable burst of fourth thoracic vertebra, initial for closed Stable burst of fourth thoracic vertebra, initial for open Unstable burst of fourth thoracic vertebra, initial for closed Unstable burst of fourth thoracic vertebra, initial for open Other of fourth thoracic vertebra, initial for closed Other of fourth thoracic vertebra, initial for open Unspecified of fourth thoracic vertebra, initial for closed Unspecified of fourth thoracic vertebra, initial for open Wedge compression of T5-T6 vertebra, initial for closed Wedge compression of T5-T6 vertebra, initial for open Stable burst of T5-T6 vertebra, initial for closed Stable burst of T5-T6 vertebra, initial for open Unstable burst of T5-T6 vertebra, initial for closed Unstable burst of T5-T6 vertebra, initial for open Other of T5-T6 vertebra, initial for closed Other of T5-T6 vertebra, initial for open Unspecified of T5-T6 vertebra, initial for closed Unspecified of T5-T6 vertebra, initial for open Wedge compression of T7-T8 vertebra, initial for closed Wedge compression of T7-T8 vertebra, initial for open Stable burst of T7-T8 vertebra, initial for closed Stable burst of T7-T8 vertebra, initial for open Unstable burst of T7-T8 vertebra, initial for closed Unstable burst of T7-T8 vertebra, initial for open Other of T7-T8 thoracic vertebra, initial for closed Other of T7-T8 thoracic vertebra, initial for open Unspecified of T7-T8 vertebra, initial for closed Unspecified of T7-T8 vertebra, initial for open Wedge compression of T9-T10 vertebra, initial for closed Wedge compression of T9-T10 vertebra, initial for open Stable burst of T9-T10 vertebra, initial for closed Stable burst of T9-T10 vertebra, initial for open Unstable burst of T9-T10 vertebra, initial for closed Page 22