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Reporting Back Pain in ICD-10-CM

by | Nov 17, 2016 | Medical Coding News, Resources | 0 comments

Orthopedic, physical therapy, and chiropractic practices see a large number of patients reporting with back pain. This common health concern is a leading cause of disability among U.S. adults of all ages. Even expert medical coding service providers concede that reporting back pain in ICD-10-CM is challenging because there are different types of codes to describe pain in this extensive area of the body.

Under ICD-10, section M54 covers dorsalgia described as a disorder characterized by marked discomfort sensation in the back region or acute or chronic pain in the posterior regions of the thorax, lumbosacral region, or the adjacent region. M54 is not a billable or specific ICD-10-CM diagnosis code and has subcategories which describe this diagnosis in greater detail.

Here are some of the billable/specific ICD-10-CM codes under M54 that can be used to indicate a diagnosis for reimbursement purposes:

  • M54.00: Panniculitis affecting regions of neck and back, site unspecified
  • M54.01: Panniculitis affecting regions of neck and back, occipito-atlanto-axial region
  • M54.9: Dorsalgia, unspecified
  • M54.10: Radiculopathy, site unspecified
  • M54.1: Radiculopathy, occipito-atlanto-axial region
  • M54.2: Cervicalgia
  • M54.30: Sciatica, unspecified side
  • M54.31: Sciatica, right side
  • M54.32: Sciatica, left side
  • M54.40: Lumbago with sciatica, unspecified side
  • M54.6: Pain in thoracic spine
  • M54.81: Occipital neuralgia

Identifying the cause and type of the back pain is essential to provide the right treatment and also to code correctly. The cause of the back pain can be determined by evaluating the frequency, duration, location, and severity of the pain as well as the associated signs and symptoms such as stiff neck, numbness, tingling the neck or foot, swelling, pain running down the legs, and mechanical issues.

Here are some documentation tips for the most common type of back pain: Low back pain – M54.5:

  • Specify the site (such as low back, thoracic, cervical, etc.)
  • State the laterality when applicable (right, left, or bilateral).
  • Identify the underlying cause of the pain.
  • State whether panniculits or radiculopathy.
  • Provide details when lumbago is present with sciatica.

Precise documentation of the examination and the findings of any diagnostic studies is necessary to determine the right interventions for the diagnosed condition.

An experienced orthopedics medical coding company can ensure accuracy in orthopedics coding and billing. The expert coders in these companies are well aware that a patient’s condition may need a single code or several codes, based on the complexity of the condition, number of complications, and comorbidities. The right diagnosis codes are assigned to coincide with the procedure codes based on local and national coverage determinations.

Reliable medical billing and coding companies provide comprehensive support covering everything from assigning diagnosis codes to patient enrollment and scheduling, insurance verification services, and accounts receivable collections.