ICD-10 Coding for Low Back Pain(M54.50, M54.51, M54.59)
Complete ICD-10-CM coding and documentation guide for Low Back Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Low Back Pain
M54.5-M54.59Primary Range
Low back pain codes including unspecified, vertebrogenic, and other specified
This range covers the primary ICD-10 codes used for documenting low back pain and its variants.
Codes for sciatica and lumbago with sciatica
These codes are used when low back pain is associated with sciatica.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.50 | Unspecified low back pain | Use when low back pain is present but no specific cause or condition is identified. |
|
| M54.51 | Vertebrogenic low back pain | Use when MRI confirms vertebrogenic origin of low back pain. |
|
| M54.59 | Other specified low back pain | Use when specific types of low back pain are identified but not covered by other codes. |
|
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 low back pain
Essential facts and insights about Low Back Pain
Primary ICD-10-CM Codes for low back pain
Decision Criteria
clinical Criteria
- Presence of low back pain without specific diagnosis
Applicable To
- General low back pain without specific cause
Clinical Validation Requirements
- Clinical documentation of low back pain without specific cause or associated conditions
Code-Specific Risks
- Risk of under-documentation leading to unspecified coding
Coding Notes
- Avoid using this code if more specific information is available.
M54.51 - Vertebrogenic low back pain
Use when MRI confirms vertebrogenic origin of low back pain.
Applicable To
- Low back pain with vertebral endplate changes
Excludes
- Disc disorders (M51.-)
Clinical Validation Requirements
- MRI showing Modic changes
- Chronic pain lasting more than 3 months
Coding Notes
Ensure MRI findings are documented to support this code.
M54.59 - Other specified low back pain
Use when specific types of low back pain are identified but not covered by other codes.
Applicable To
- Muscular strain
- Sacroiliac joint dysfunction
Excludes
- Sciatica (M54.3-)
Clinical Validation Requirements
- Clinical documentation specifying the type of low back pain
Coding Notes
Ensure specific type of low back pain is documented.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting 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: Inaccurate diagnosis and treatment, Regulatory: Non-compliance with documentation standards, Financial: Potential for claim denials
Mitigation Strategy
Ensure all imaging results are included in patient records, Train staff on documentation requirements
Impact
Reimbursement: May lead to claim denials or reduced reimbursement, Compliance: Non-compliance with coding guidelines, Data Quality: Decreases accuracy of clinical data
Mitigation Strategy
Document specific causes or conditions associated with low back pain
Impact
High audit risk when 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 Low Back Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Low Back Pain
Use these documentation templates to ensure complete and accurate documentation for Low Back Pain. These templates include all required elements for proper coding and billing.
Chronic vertebrogenic low back pain
Specialty: OrthopedicsRequired Elements
- Patient history
- MRI findings
- Pain duration and severity
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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