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Home/Diagnosis/ICD-10 Coding for Back Pain

ICD-10 Coding for Back Pain

M54.50
M54.51
G89.21

Complete ICD-10-CM coding and documentation guide for icd-10 coding for back pain includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Dorsalgia
Low Back Pain
Lumbago
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Key Information: ICD-10 Coding for Back Pain

Essential facts and insights about ICD-10 Coding for Back Pain

Use ICD-10 code M54.50 for low back pain, unspecified, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Low back pain, unspecified

Billable Code
M54.50
Billable

Diagnostic Criteria

clinical:
  • Pain localized to lumbar region without specific cause.

Applicable To

  • • General low back pain

Important Notes

  • • Avoid using unspecified codes when more specific information is available.

Vertebrogenic low back pain

Billable Code
M54.51
Billable

Diagnostic Criteria

clinical:
  • Imaging shows vertebral endplate edema or Modic changes.

Applicable To

  • • Pain due to vertebral endplate changes

Important Notes

  • • Documentation must include imaging findings.

Chronic pain due to trauma

Billable Code
G89.21
Billable

Diagnostic Criteria

clinical:
  • Pain persists more than 3 months post-injury.

Applicable To

  • • Chronic pain following injury

Important Notes

  • • Sequence G89.21 after the code for the injury if the encounter is for pain management.

Osteoporosis with current pathological fracture

Non-Billable
M80.0
Non-Billable

Diagnostic Criteria

clinical:
  • DEXA scan T-score ≤-2.5 and fracture history.

Applicable To

  • • Fracture due to osteoporosis

Important Notes

  • • Do not use traumatic fracture codes for osteoporotic fractures.
Ancillary Codes

Additional codes that may be used with this diagnosis

G89.29

Other chronic pain

Use when the encounter is primarily for pain management.

Frequently Asked Questions

What is the ICD-10 code for back pain?

The ICD-10 code for unspecified low back pain is M54.50. For more specific conditions, codes like M54.51 for vertebrogenic low back pain may be used.

How do you code chronic back pain?

Chronic back pain is coded with G89.29 when the focus is on pain management. If related to trauma, use G89.21.

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