ICD-10 Coding for Dorsalgia(M54.5, M54.8, M54.9)
Complete ICD-10-CM coding and documentation guide for Dorsalgia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dorsalgia
M54.0-M54.9Primary Range
Dorsalgia, including specific and unspecified back pain
This range covers various types of back pain, including specific and unspecified dorsalgia.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.5 | Low back pain | Use when the patient presents with specific lumbar region pain. |
|
| M54.8 | Other dorsalgia | Use when the patient presents with thoracic or sacral pain. |
|
| M54.9 | Unspecified dorsalgia | Use only when documentation does not specify the location of the back pain. |
|
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 dorsalgia
Essential facts and insights about Dorsalgia
Primary ICD-10-CM Codes for dorsalgia
Decision Criteria
documentation Criteria
- Documentation must specify lumbar region pain.
Applicable To
- Lumbago
- Pain in lumbar region
Excludes
- Lumbago with sciatica (M54.4-)
Clinical Validation Requirements
- Clinical examination confirming lumbar pain
- Patient history indicating low back pain
Code-Specific Risks
- Risk of using unspecified code if lumbar region is not documented
Coding Notes
- Ensure documentation specifies the lumbar region to avoid using unspecified codes.
M54.8 - Other dorsalgia
Use when the patient presents with thoracic or sacral pain.
Applicable To
- Thoracic pain
- Sacral pain
Excludes
- Radiculopathy (M54.1-)
Clinical Validation Requirements
- Clinical examination confirming thoracic or sacral pain
- Patient history indicating pain in these regions
Coding Notes
Ensure documentation specifies thoracic or sacral region to avoid using unspecified codes.
M54.9 - Unspecified dorsalgia
Use only when documentation does not specify the location of the back pain.
Applicable To
- Back pain NOS
Excludes
- Specific back pain codes (M54.0-M54.8)
Clinical Validation Requirements
- Lack of specific documentation regarding the location of back pain
Coding Notes
Avoid using unless absolutely necessary due to unspecified documentation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dorsalgia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.5.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Increases risk of coding audits., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Train staff on documentation standards, Use templates to ensure completeness
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Increases risk of audit due to unspecified coding., Data Quality: Decreases data quality and specificity.
Mitigation Strategy
Ensure documentation specifies the region of pain to use a more specific code.
Impact
High audit risk when using M54.9 due to lack of specificity.
Mitigation Strategy
Ensure documentation specifies the region of pain.
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 Dorsalgia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dorsalgia
Use these documentation templates to ensure complete and accurate documentation for Dorsalgia. These templates include all required elements for proper coding and billing.
Chronic low back pain
Specialty: OrthopedicsRequired Elements
- Pain location
- Duration
- Aggravating factors
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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