Low back pain 1 M54.5 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 The 2020 edition of ICD-10-CM M54.5 became effective on October 1, 2019. 3 This is the American ICD-10-CM version of M54.5 - other international versions of ICD-10 M54.5 may differ.
724.5 ICD-9 Back Pain/Backache NOS 1 724.5 Back Pain, Lumbosacral, Chronic 2 724.5 Back Pain, Left 3 724.5 Back Pain, Upper 4 724.5 Back Pain, Chronic, Intermittent 5 724.5 Back Pain, Right 6 724.5 Back Pain, Acute 7 724.5 Back Pain, Chronic
To supplement this low back coding deletion, CMS suggested that providers use other, more specific codes—some which you may recognize, and some of which are totally new. Here are some potential code replacements that you can use beginning October 1:
For upper or middle back pain we mostly code 724.1, thoracic pain, since the middle vertebral column generally consists of thoracic spines. For lower back pain or lumbago it always leads to 724.2 for the lumbar spine pain, since the lower part of the vertebral column is mainly of lumbar spines.
Its corresponding ICD-9 code is 724.2. Code M54. 5 is the diagnosis code used for Low Back Pain (LBP).
M54. 50 (Low back pain, unspecified) M54. 51 (Vertebrogenic low back pain)
Here are some potential code replacements that you can use beginning October 1: S39. 012, Low back strain.
M54. 50 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM M54.
Instructions for coding COVID-19U07.1 COVID-19, virus detected.U07.2 COVID-19, virus not detected.U08.9 COVID-19 in its own medical history, unspecified.U09.9 Post-infectious condition after COVID-19, unspecified.U10.9 Multisystemic inflammatory syndrome associated with COVID-19, unspecified.More items...
16: Radiculopathy Lumbar region.
M54. 59, other low back pain is used for lower back pain that can be attributed to a specific reason but there is not an applicable code available that describes or defines it. (You can name it but it is does not have its own specific code (i.e. facet syndrome.)
ICD-9 Code Transition: 723.1 Code M54. 2 is the diagnosis code used for Cervicalgia (Neck Pain). It is a common problem, with two-thirds of the population having neck pain at some point in their lives.
9: Fever, unspecified.
17: Radiculopathy Lumbosacral region.
M54. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM M54.
Currently, the U.S. is the only industrialized nation still utilizing ICD-9-CM codes for morbidity data, though we have already transitioned to ICD-10 for mortality.
M54. 59, Other low back pain is used for lower back pain that can be attributed to a specific reason but there is not an applicable code available that describes or defines it. Ultimately, best practice for an acupuncture provider when coding low back pain is to use M54. 50 or M54.
ICD-10 Code for Other low back pain- M54. 59- Codify by AAPC.
ICD-9 Code Transition: 723.1 Code M54. 2 is the diagnosis code used for Cervicalgia (Neck Pain). It is a common problem, with two-thirds of the population having neck pain at some point in their lives.
ICD-10 code G89. 29 for Other chronic pain is a medical classification as listed by WHO under the range - Diseases of the nervous system .
In the coding guidelines it has a section devote to pain coding. The 338.xx codes are to be used for pain control and pain management encounters. It discusses how you are allowed to code the symptom of pain along with the definitive condition say DJD when the purpose of the encounter is to treat the pain and not the disease. It also discusses the documentation and that the provider must state acute or chronic pain to use a 338.xx code. If the drug is being given to relieve pain and not treat the disease then I would use a pain code first per the guidelines. If the documentation does not specify acute or chronic then following the pain guidelines and the fact that the treatment is directed to the pain I would use the 719.xx code for the pain as the drug is not being used a threapeutic measure for the DJD. I suggest reading the pain guidelines first.
CC: Pain#N#PMH: DJD#N#Treatment: Injection#N#I would code DJD as the primary diagnosis 715.90 , because looking at past medical history as DJD, and knowing the disease process of DJD as non-curable but treatable, it is not resolved and that would be the cause of the patient's chief complaint. Also the DJD was not specified as localized or generalized and no site mentioned. The second diagnosis I would use is V58.65 ( long term use of Steroids) for the injection if that is the medication the doctor is administering for the pain and/or inflammation. The reason I chose V58.65 is because the coding guideline states," Assign a code from subcategory V58.6, Long term (current) drug use, if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis)......etc. Hope this helps.
Code 338.3 is used to classify pain related to, associated with, or due to a tumor or cancer whether primary or secondary. This code is used as the principal code when the admission or encounter is for pain control or pain management. In this case, the underlying neoplasm should be reported in addition. When the encounter is for management of the neoplasm and the pain is also documented, it is appropriate to assign code 338.3 as an additional diagnosis. For example, a patient who was admitted for insertion of a pump for control of pain due to liver metastasis from a history of breast cancer would be coded to 338.3, 197.7, and V10.3. In another example, a patient is seen because of lower back pain; the patient has prostate cancer, and a bone scan shows metastasis to bones. The encounter would be coded to 198.5, 185, and 338.3.
Documentation is the key to the correct code assignment when coding these conditions. Several of the codes are similar but vary slightly. Code 338.0 describes central pain syndrome; 338.4, Chronic pain syndrome; and 338.29, Other chronic pain. These conditions are different, and code assignments are based upon physician documentation.
This encounter would be coded to 338.19 and 722.10.
For example, a patient diagnosed with chronic abdominal pain due to chronic cholelithiasis would be coded to 574.20, while a patient who is being treated with spinal cord stimulation because of chronic pain syndrome due to thoracic spondylosis with myelopathy would be coded to 338.4 and 721.41.
Category 338 should be used in conjunction with site-specific pain codes (including codes from chapter 16) if category 338 codes provide additional information about the pain, such as if it is acute or chronic. The sequencing of category 338 codes along with site-specific pain codes (including chapter 16 codes) depends on the circumstances of the encounter or admission and must follow these guidelines:
Chronic pain is classified to subcategory 338.2. There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used to guide the use of the code, not an interpretation by the coding professional.
New codes for generalized pain, central pain syndrome, and postoperative pain were approved for ICD-9-CM in FY 2007 and went into effect October 1, 2006. Previously codes for pain were found in the body system chapters and the symptom chapters. A new category was created in the nervous system chapter for some of these conditions, and the codes differentiate central pain syndrome, acute pain, and chronic pain.
Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions.
M54.5 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
Sciatica – Pain which radiates down to one or both the legs from the lower back caused due to compression of the sciatic nerve by a herniated disk or a bone spur. Lumbago- The medical term for low back pain.
Back pain, medically called Dorsalgia is a very common physical discomfort affecting 8 out of 10 people both young and the old. The pain can be in the cervical, cervicothoracic, thoracic, thoracolumbar, Lumbar or lumbosacral regions. It can be felt as a dull, persistent ache or a sudden sharp pain.
Lumbar region – The lower back region of the spine which is curved slightly inwards and made of 5 vertebrae (L1-L5). Lumbosacral region – The region connecting the last lumbar vertebrae to the sacrum which is made of 5 bones fused together.
Chronic back pain – Back pain is said to be chronic if it is a constant nagging pain usually lasting for more than 3-6 months duration, which begins to affect the daily routine of the person.
Thoracic region – The longest region of the spine which extends from the base of the neck to the abdomen. It comprises of 12 vertebrae (T1 to T12).
When the patient’s back pain is specified as acute or chronic, due to trauma, post-procedural or neoplasm related, the code from the category G89 also needs to be coded along with the site-specific pain code. The sequencing of the codes will be based on the reason for the visit.
Back pain being a symptom of an underlying disease in most cases is coded only in the absence of a confirmed diagnosis of an underlying condition like intervertebral disc disorders, traumatic disc fracture, muscle strain etc..
This August, CMS published its latest round of ICD-10 changes—including the deletion of ICD-10 code M54.5, low back pain, effective October 1, 2021.
So, here’s the real question: How the heck can CMS justify deleting such a commonly used code? Well, CMS has explained that it’s deleting M54.5 because it lacks specificity (and we all know how important coding specificity is to ICD-10). To supplement this low back coding deletion, CMS suggested that providers use other, more specific codes—some which you may recognize, and some of which are totally new. Here are some potential code replacements that you can use beginning October 1:
No, oddly enough it was mainly Medicare and BCBS... It wasn't the primary diagnosis so I just deleted the code from the claim.