Back pain ICD 10 Coding tips for Coders

Basics of Back pain ICD 10 Coding.

We already know that there is a big difference between ICD 9 and ICD 10 codes. Since the time I have started using ICD 10 codes, I have seen many challenges in diagnosis coding. For example, the concept of Excludes 1 and Excludes 2,  the initial subsequent encounter and sequela codes for injuries. There are many new guidelines for coding ICD 10 codes. You will also get the new Status Z codes which have replaced the V codes of ICD 9. These are the real reason for the number of increase in the ICD 10 codes. For pregnancy complication ICD 10 codes, you will get a new category of codes (Z3A) for coding weeks of gestation. So, be prepared with such topics before using ICD 10 codes. Today, we will learn the Back pain ICD 10 Coding guidelines.

Earlier in ICD 9 we use to use only one code for coding back pain, 724.5 (backache). But, now with the implementation of the new ICD 10 codes, you can see that we have more specific ICD 10 code for back pain. Also, we have separate ICD 10 code for  lumbar back pain and thoracic back pain. If you are coding for neck pain or cervical pain, we have separate ICD10 code (M54.2) for that as well.

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Category for ICD 10 code for Back/Lumbar radiculopathy pain

M54 category is used for coding backache or back pain. If you are coding any pain specific to spinal region it will lead to M54 category. Below you can see a lists of ICD10 codes related to back pain.

M54 Dorsalgia
Excludes1: psychogenic dorsalgia (F45.41)

M54.0Panniculitis affecting regions of neck and back
Excludes1: lupus panniculitis (L93.2)

panniculitis NOS (M79.3)

relapsing [Weber-Christian] panniculitis (M35.6)

M54.00 Panniculitis affecting regions of neck and back, site unspecified

M54.01 Panniculitis affecting regions of neck and back, occipito-atlanto-axial region

M54.02 Panniculitis affecting regions of neck and back, cervical region

M54.03 Panniculitis affecting regions of neck and back, cervicothoracic region

M54.04 Panniculitis affecting regions of neck and back, thoracic region

M54.05 Panniculitis affecting regions of neck and back, thoracolumbar region

M54.06 Panniculitis affecting regions of neck and back, lumbar region

M54.07 Panniculitis affecting regions of neck and back, lumbosacral region

M54.08 Panniculitis affecting regions of neck and back, sacral and sacrococcygeal region

M54.09 Panniculitis affecting regions, neck and back, multiple sites in spine

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When not to code diagnosis code for Back/Lumbar radiculopathy pain

Radiculopathy or radiculitis includes the pain of that region. Hence, when we are reporting any radiculopathy ICD 10 code we should not report any ICD 10 code for back pain. For example, if we are coding lumbar radiculopathy (M54.16), then you should not assign M54.50 (Lumbar back pain) along with M54.16.

M54.1Radiculopathy
Brachial neuritis or radiculitis NOS
Lumbar neuritis or radiculitis NOS
Lumbosacral neuritis or radiculitis NOS
Thoracic neuritis or radiculitis NOS
Radiculitis NOS
Excludes1: neuralgia and neuritis NOS (M79.2)

radiculopathy with cervical disc disorder (M50.1)

radiculopathy with lumbar and other intervertebral disc disorder (M51.1-)

radiculopathy with spondylosis (M47.2-)

M54.10Radiculopathy, site unspecified

M54.11Radiculopathy, occipito-atlanto-axial region

M54.12Radiculopathy, cervical region

M54.13Radiculopathy, cervicothoracic region

M54.14Radiculopathy, thoracic region

M54.15Radiculopathy, thoracolumbar region

M54.16Radiculopathy, lumbar region

M54.17Radiculopathy, lumbosacral region

M54.18Radiculopathy, sacral and sacrococcygeal region

M54.2Cervicalgia

Excludes1: cervicalgia due to intervertebral cervical disc disorder (M50.-)

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Excludes1: lesion of sciatic nerve (G57.0)

sciatica due to intervertebral disc disorder (M51.1-)

sciatica with lumbago (M54.4-)

M54.30 Sciatica, unspecified side

M54.31 Sciatica, right side

M54.32 Sciatica, left side

M54.4Lumbago with sciatica
Excludes1: lumbago with sciatica due to intervertebral disc disorder (M51.1-)

M54.40Lumbago with sciatica, unspecified side

M54.41Lumbago with sciatica, right side

M54.42 Lumbago with sciatica, left side

M54.5  Low back pain
Excludes1: low back strain (S39.012)
lumbago due to intervertebral disc displacement (M51.2-)
lumbago with sciatica (M54.4-)

M54.50 Low back pain, unspecified
Loin pain
Lumbago NOS

M54.51
Vertebrogenic low back pain
Low back vertebral endplate pain

M54.59
Other low back pain
Excludes1: low back strain (S39.012)

lumbago due to intervertebral disc displacement (M51.2-)

lumbago with sciatica (M54.4-)

M54.6Pain in thoracic spine

Excludes1: pain in thoracic spine due to intervertebral disc disorder (M51.-)

M54.8 Other dorsalgia
Excludes1: dorsalgia in thoracic region (M54.6)

low back pain (M54.5)

M54.81Occipital neuralgia

M54.89Other dorsalgia

M54.9Dorsalgia, unspecified

Backache NOS
Back pain NOS

ICD-10 is required for use by physicians and healthcare providers under the Health Insurance Portability & Accountability Act (HIPAA).

CPT codes supporting ICD 10 code for Back/Lumbar radiculopathy pain

Back pain generally caused for spinal spondylosis, degeneration of intervertebral disc or disc displacement. To diagnosis the exact cause of back pain, mainly MRI or CT exam of lumbar, cervical or thoracic spine is performed.

Some to the surgical procedures like spinal injection, laminotomy etc, can also help in treated the spinal back pain completely.