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ICD-10 Coding for Acute Low Back Pain(M54.50, M54.51, M54.59)

Complete ICD-10-CM coding and documentation guide for Acute Low Back Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Acute LBPAcute Lumbago

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Related ICD-10 Code Ranges

Complete code families applicable to Acute Low Back Pain

M54.50-M54.59Primary Range

Acute low back pain codes

This range includes codes for acute low back pain with various specifications, including vertebrogenic and other specified types.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
M54.50Acute low back pain, unspecifiedUse for acute low back pain without specific underlying cause or imaging findings.
  • Documentation of acute onset and duration less than 3 months
  • Absence of red flags
M54.51Vertebrogenic low back painUse when imaging confirms vertebral pathology.
  • MRI showing Modic Type 1 changes
M54.59Other specified low back painUse for specified causes of acute low back pain not related to vertebral pathology.
  • Physical exam findings supporting specific diagnosis

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for acute low back pain

Essential facts and insights about Acute Low Back Pain

The ICD-10 code for acute low back pain is M54.50, with specific codes for vertebrogenic pain like M54.51.

Primary ICD-10-CM Codes for acute low back pain

M54.50
Acute low back pain, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • Acute onset of symptoms less than 3 months

Applicable To

  • Acute non-specific low back pain

Excludes

  • Chronic low back pain (M54.5-)

Clinical Validation Requirements

  • Documentation of acute onset and duration less than 3 months
  • Absence of red flags

Code-Specific Risks

  • Risk of using unspecified code without adequate documentation of acute nature

Coding Notes

  • Ensure documentation specifies acute nature and absence of chronic conditions.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Strain of muscle and tendon of lower back

S39.012S
Use when acute low back pain is due to a strain.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Vertebrogenic low back pain

M54.51
Requires imaging confirmation of vertebral pathology such as Modic changes.

Acute low back pain, unspecified

M54.50
Use when no imaging findings are present.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Acute Low Back Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.50.

Impact

Clinical: Misclassification of pain type., Regulatory: Non-compliance with ICD-10 guidelines., Financial: Potential for claim denial.

Mitigation Strategy

Always include onset and duration in documentation.

Impact

Reimbursement: May lead to lower reimbursement if coded as unspecified., Compliance: Non-compliance with coding guidelines for specificity., Data Quality: Impacts data accuracy for clinical research and reporting.

Mitigation Strategy

Document onset and duration clearly to justify acute coding.

Impact

High risk of audit if unspecified codes are used without justification.

Mitigation Strategy

Ensure documentation supports the specificity of the code used.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Acute Low Back Pain, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Acute Low Back Pain

Use these documentation templates to ensure complete and accurate documentation for Acute Low Back Pain. These templates include all required elements for proper coding and billing.

Acute low back pain in primary care

Specialty: Family Medicine

Required Elements

  • Onset and duration of pain
  • Physical exam findings
  • Absence of red flags

Example Documentation

Patient presents with acute low back pain for 2 weeks, no radiation, negative straight leg raise.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Low back pain.
Good Documentation Example
Acute low back pain for 2 weeks, no neurological deficits.
Explanation
The good example provides specific details about the duration and absence of red flags.

Need help with ICD-10 coding for Acute Low Back Pain? Ask your questions below.

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