low back pain icd 10

Low Back Pain ICD 10 & ICD 11 (2022 Updated)

Are you looking for Low Back Pain ICD 10 & 11 Codes? This article includes all the medical codes you will need to report Low Back Pain, as well as other specific ICD 10 codes such as Low Back Pain with Radiculopathy and Sciatica. Read on for a summary of the necessary ICD 10 & 11 codes followed by a further description.

What Is Low Back Pain?

Low back pain ICD 10 can be described as a stinging and burning pain that affects the backside of the body and moves towards the hips and thighs area. This pain mostly resulted from injury, strains, degenerative changes as common in old ages and different heavyweight exercises. Usually, doctors will prescribe some sort of medications, pain injections with prosthetic devices to treat this condition. To bill those services to insurances, ICD diagnosis codes for the low back have been effective for years. 

Low Back Pain ICD 10

Before 10/1/2021, diagnosis code M54.5 for the low back pain was used for reimbursement purposes. This code resides in the (M00-M99) musculoskeletal chapter. According to ICD 10 guidelines, the “pain” term in the alphabetic index will direct to choose code for low back pain in the tabular index. Under main category M54 and code M54.5, there are exclude 1 notes with diagnosis codes that cannot be reported with M54.5 on the same claim.

After 10/1/2021, M54.5 became a subcategory and three codes have been added under M54.5:

  • M54.50 Low back pain, unspecified (can also be used for lumbago NOS and Loin pain)
  • M54.51 Vertebrogenic back pain (low back vertebral endplate pain)
  • M54.59 Other low back pain

ICD 10 code for low back pain with sciatica, cervicalgia, or pain in the thoracic area should not be confused. Sciatica is pain associated with the sciatic nerve, mostly radiating to one side of the lower body area, it has a separate category of code listing M54.3. In some cases when sciatica and low back pain are both affecting a patient, subcategory M54.4 should be used to report this combined condition. Thoracic pain is the condition of the back area as well as other dorsalgia but when selecting a code, only the M54.5 subcategory is most appropriate for low back pain. If thoracic pain is present, a combination of M54.6 and code from M54.5 can be used. The ICD 10 code for low back pain is M54.5.

Different Coding Scenarios

Follow the coding of different scenarios in ICD 10 as follows;

  • Low back pain, acute low back pain – only code M54.50
  • Intractable low back pain – M54.59
  • Chronic low back pain – G89.29, M54.50
  • Chronic intractable low back pain – G59.29, M54.59
  • Radiculopathy of right/left side with low back pain – only code M54.16
  • Sciatica of right side with low back pain – only use M54.41
  • Sciatica of left side with low back pain – only code M54.42
icd 10 code for low back pain

What Does Code M54.9 Mean?

M54.9 is an unspecified code that is used when there is no specified explanation in medical notes is available to describe the exact location of the pain. Description of M54.9 states as “Dorsalgia, unspecified” and under the main description, there is back pain NOS and backache NOS. If the medical provider has not mentioned the pain as lower, upper, sciatic, or thoracic, M54.9 is the code of choice for this situation.

ICD 10 & 11 Codes For Low Back Pain

This article covers the following Low Back Pain ICD 10 & 11 Codes:

List With Low Back Pain ICD 10 Codes

  • ICD 10 M54Dorsalgia
  • ICD 10 M54.1Radiculopathy
  • ICD 10 M54.10 – Radiculopathy, site unspecified
  • ICD 10 M54.16 – Radiculopathy, lumbar region
  • ICD 10 M54.3 – Sciatica
  • ICD 10 M54.4 – Lumbago with Sciatica
  • ICD 10 M54.40 – Lumbago with sciatica, unspecified side
  • ICD 10 M54.41 – Lumbago with sciatica, right side
  • ICD 10 M54.42 – Lumbago with sciatica, left side
  • ICD 10 M54.5 – Low Back Pain
  • ICD 10 M54.50 – Low Back Pain, Unspecified
  • ICD 10 M54.51 – Vertebrogenic Low Back Pain
  • ICD 10 M54.59 – Low Back Pain, Site Unspecified
  • ICD 10 M54.6 – Pain In Thoracic Spine
  • ICD 10 M54.9 – Dorsalgia, Unspecified
  • ICD 10 G89 – Pain, Not Elsewhere Classified
  • ICD 10 G89.21 – Chronic Pain Due To Trauma
  • ICD 10 G89.29 – Other Chronic Pain

List With Low Back Pain ICD 11 Codes

  • ICD 11 ME84.20 – Lumbago with Sciatica
  • ICD 11 ME84.2Z – Low Back Pain, Unspecified
  • ICD 11 ME84.2Y – Other Specified Low Back Pain
  • ICD 11 MG30.02 – Chronic Primary Musculoskeletal Pain

Left Lower Back Pain ICD 10

Currently, there is not a code that exists to describe the literality of lower back pain. M54.50 should be used whenever the left side of lower back pain is provided with an assessment. However, if Sciatica is present with lower back pain then M54.41 and M54.42 should be used for the left side respectively. The Left Lower Back Pain ICD 10 code is M54.50.

Right Lower Back Pain ICD 10

Currently, there is no specific code to define the literality of lower back pain. M54.50 should be used whenever the right side of lower back pain is provided with an assessment. However, if Sciatica is present with lower back pain then M54.41 and M54.42 should be used for the right side respectively. The Right Lower Back Pain ICD 10 code is M54.50.

Do You Code Lower Back Pain With Radiculopathy?

Radiculopathy deals with damage to the nerve of a specific spine area, most specifically; it can be described as lumbar, cervical, thoracic, and sacral radiculopathy. A radiculopathy is a group of symptoms of the spine area and it covers pain, itching, and other associated symptoms in it.

If a doctor provides an assessment of “Lumbar radiculopathy with pain”, only radiculopathy of the lumbar area “M54.16” should be coded. There is no need to code lower back pain or lumbago separately. Coding pain of the same spinal area as radiculopathy is denied mostly by payers. If the spinal area for radiculopathy and pain is different, coding of both conditions is allowed separately. The ICD 10 code for low back pain with radiculopathy is M54.10.

What Is The Difference Between M54.50 And M54.59?

M54.50 is an unspecified code and M54.59 should be seen as NEC code here. Suppose, a medical assessment of the newly admitted patient in medical notes is updated as Lower back pain. With the available information, M54.50 is the best option as unspecified or NOS (not otherwise specified) code. After admission, the Doctor completes a visit and document the condition as “Episodic lower back pain”. This term of “episodic” is more specific but there is no existence of specified code for mentioned condition, M54.59 is the best option here as NEC (not elsewhere classified code). Using NEC code means that system does not provide a more specified code for a medical condition that is specified more accurately by the Medical provider in the documentation.

What Is ICD 11 Code For Lower Back Pain?

As the world is moving towards ICD-11 codes from 2022, new coding guidelines, new codes, and conventions are effective, It can be tough to move from ICD-10 to ICD-11 as a new revision of disease codes if a lot different than old ones. ICD-11 is going to provide more specified codes with multiple subgroups under its belt. A category of four rather than three is used and a code comprised of six-digit is completed one. Follow the alphabetic index and then verify the code in the tabular index, It will lead to ME84.2Z that states “Low back pain, unspecified”. This code falls under the acute pain category in ICD-11, there is a separate code available for chronic lower back pain. This kind of specificity is unavailable in the ICD-10 system. The ICD 11 code for lower back pain is ME84.2Z.

ICD 11 Code For Right Low Back Pain

There is still lacking literality in the ICD-11 system related to low back pain. The unspecified code ME84.2Z should be used if the right side of low back pain is mentioned in Medical documents. The ICD 11 code for right lower back pain is ME84.2Z.

ICD 11 Code For Left Low Back Pain

Literality for low back pain is not available currently in the ICD-11 coding system, using ME84.2Z with extension code for causes of low back pain would be sufficient for this medical term. The ICD 11 code for left lower back pain is ME84.2Z.

chronic low back pain icd 10

CPT Code For Low Back Pain

Low back pain is a diagnosis that is treated by doctors using the medication, injections, prostheses, and surgeries on daily basis. Orthopedics specialty deals with all sorts of low back problems. CPT codes from musculoskeletal and medicine with DMEs and supplies section from HCPCS are used to code the complete treatment. Some guidelines should be followed while coding for services related to low back pain;

  • ICD 10 code for pain and of the same area of the fracture or injury should never be coded together.
  • Whenever coding for injections, the primary code of low back should be used as a primary one.
  • Consulting the Exclude 1 notes before completing a claim
  • following the LCD of state to check the requirements of group 1 and group 2 diagnosis, and medical necessity   

How To Code Low Back Pain With Sciatica ICD 10

The following information is specifically written to help you decipher how to code low back pain with sciatica ICD 10.

What Is Low Back Pain With Sciatica?

Sciatica is the pain of the sciatic nerve that radiates from the back towards the right and the lower extremity of the body. It can be painful to lie on the back and maybe better to rest with a pillow under the knees. Physical therapy is required to strengthen the muscles and relieve spasms. 

Low Back Pain With Sciatica ICD 10 Code

The low back pain with sciatica ICD 10 code is M54.40. If a condition is documented as Sciatica with low back pain, coding both conditions separately is prohibited according to ICD 10 guidelines. Combination codes in the M54.4 subcategory are available to fully describe the condition. Code should be selected after Consulting excludes notes to avoid overlapping of condition coding.

How To Code Low Back Pain Without Sciatica ICD 10

The following information is specifically written to help you decide how to code low back pain without sciatica ICD 10.

Low Back Pain Without Sciatica ICD 10 Code

The low back pain without sciatica ICD 10 code is M54.50. Low back pain without sciatica does not need to have separate codes in the ICD-10 coding system; only low back pain should be coded in this situation. Remember not to use other specified codes from the M54 category for pain without sciatica, as the condition does not qualify for the NEC rule.

Chronic Midline Low Back Pain With Bilateral Sciatica ICD 10 Code

The chronic midline low back pain with bilateral sciatica ICD 10 code is G89.29, M54.41, and M54.42. In this scenario, three codes are required to fully describe the condition. There is no combination code available for this medical term. One code from chronic pain category “G89.29” and two codes for bilateral pain of sciatica, M54.41 for the right side and M54.42 for the left side should be used.

Low Back Pain With Left Side Sciatica ICD 10 Code

The low back pain with left side sciatica ICD 10 code is M54.42. M54.42 is a combination code for lumbago with sciatica for reimbursement purposes. Medical notes should be carefully evaluated to check if the low back pain is due to any disc disorder. In that case, a combination code for pain with sciatica should not be used.

Low Back Pain With Right Side Sciatica ICD 10 Code

The low back pain with right side sciatica ICD 10 code is M54.41. ICD 10 code M54.41 should be used, whenever low back pain with sciatica is mentioned in medical notes; using M54.5 with M54.41 is not allowed to avoid overlapping and denial of services.

Acute Low Back Pain With Sciatica

M54.41 and M54.42 codes should be used for acute low back pain with sciatica of left and right sides respectively. If the literality is not mentioned in the documentation, M54.40 should be used. The ICD 10 code for acute low back pain with sciatica is M54.40.

Low Back Pain With Sciatica ICD 11 Code

Lumbar back pain with sciatica is coded by a single combination category or stem code in ICD-11. ME84.20 should be used without any extension code unless there is another diagnosis related to vertebral disc disorder. If the patient suffers from disc disorder then a combination stem code for sciatica with disc order should be used only. The ICD 11 code for low back pain with sciatica is ME84.20.

Low Back Pain Without Sciatica ICD 11 Code

ME84.2Z should be used for only low back pain when the sciatic condition is not present. The ICD 10 code for low back pain without sciatica is ME84.2Z

icd 10 code for chronic low back pain

How To Code Acute Low Back Pain

The following information is specifically written to help you decipher how to code acute low back pain.

What Is Acute Low Back Pain?

Acute low back pain is a severe form of low back pain, is short-term but the feeling can be sharp and exhausting. Acute pain mostly happened because of some injury, fracture, or severity of degenerative process of skeletal bodies. Instant pain relief and injections in nerves are the first choices of treatment for acute low back pain. 

ICD 10 Code For Acute Low Back Pain

No specified code for the term “acute” when coding for low back pain, Code M54.50 will accurately describe condition coding, no classification for severity is present currently in the ICD-10 system. For acute low back pain, use code M54.50 as an acute condition is covered under its description according to the ICD-10 system. If a fracture or injury of the lumbar area has been confirmed, acute pain of the lumbar area should not be coded, as pain is associated with fracture or injury of the same area. Most government and commercial payers will deny coding both conditions on the same claim. The ICD 10 code for acute low back pain is M54.50

Acute Bilateral Low Back Pain With Bilateral Sciatica ICD 10

The acute bilateral low back pain with bilateral sciatica ICD 10 code is M54.41 and M54.42. Combination codes for lumbago with sciatica from the M54.4 category should be used for reimbursement purposes. No classification for acute nor bilateral pain. M54.41 and M54.42 for lumbago with sciatic for right and left side pain are codes of choice here.

Acute Left Sided Low Back Pain With Sciatica ICD 10

The acute left sided low back pain with sciatica ICD 10 code is M54.42. Literality can only be coded when sciatica is present with low back pain, M54.42 is for the left side will accurately complete the condition coding.

Acute Right Sided Low Back Pain With Sciatica ICD 10

The acute right sided low back pain with sciatica ICD 10 code is M54.41. M54.41 for low back pain with sciatica of the right side is used to report when documented in medical notes.

Acute Low Back Pain ICD 11 Code

The Acute low back pain ICD 11 code is ME84.2Z. ICD 11 coding system has provided a separate stem code for chronic pain but there is no separate subcategory for acute pain. ME84.2Z should be used for acute low back for billing purposes.

Chronic Lumbago With Sciatica

According to ICD 10 guidelines, if a medical document states that pain is chronic with sciatica, the system advises to use a code from category G89 first and then M54. Assume, an office visit is performed to evaluate the back pain condition and provider documents in assessment “Chronic low back pain with right side sciatica”, first code G89.29 as chronic pain and then M54.41 for sciatica with the right side of lumbago. In the case of bilateral sciatic pain, both codes M54.41 and M54.42 should be used to fully describe the condition. The ICD 10 code for chronic lumbago with sciatica is G89.29, M54.40.

How To Code Intractable Low Back Pain

The following information is specifically written to help you decipher how to code ICD 10 intractable low back pain.

What Is Intractable Low Back Pain?

Intractable is a term that is used by Medical doctors when a specific condition cannot be fully treated.  Other treatment options rather than active care are used in this condition to lower down the severity of the condition. Management modalities can include pain relief, exercises, medications, diet, and behavioral counseling.

ICD 10 Intractable Low Back Pain

The ICD 10 Intractable Low Back Pain code is M54.59. In the ICD 10 system, there are not many specific diagnoses available to fully code a condition when it’s intractable. According to ICD-10 guidelines, should use the NEC code of the same category to describe the condition.

Description of “Intractable low back pain” falls under other specified pain of lumbar area and the most appropriate code is M54.59 to fully describe the condition. Even though intractable is one of the severe forms of the chronic condition, but a code from the chronic category should not be used unless it’s mentioned in the assessment by Doctor.

Intractable Low Back Pain ICD 11

The Intractable Low Back Pain ICD 11 code is ME84.2Y. ICD 11 has also provided an alternative to the NEC of the ICD-10 system. Checking the alphabetic index for the main term and then looking for the tabular index will direct to use ME84.2Y for other specified low back pain. NEC or NOS terms are not used here, but the mode of selecting another specified code is the same.

Chronic Intractable Low Back Pain ICD 10

The chronic intractable low back pain ICD 10 code is G89.29, M54.59. If a condition is assessed as chronic intractable low back pain, a code from the category of chronic pain, G89.29 in this situation, should be used following M54.59 as other specified pain of lower back. Selecting a chronic pain code becomes very important while coding for the facility, so, do not miss a single category. If a claim is billed once for the G89 category, keep using it until the condition gets resolved.

Chronic Intractable Low Back Pain With Radiculopathy ICD 10

The Chronic Intractable Low Back Pain With Radiculopathy ICD 10 code is G89.29, M54.10. As low back pain is an essential component of radiculopathy and is not allowed to code with the M54.1 subcategory. Radiculopathy is coded as M54.10 when the area of disease is not defined, mostly M54.16 is assumed for low back pain with radiculopathy for the lumbar region. G89.29 for chronic pain can also be coded here; however, coding from M54.1 would also be sufficient.

Chronic Intractable Low Back Pain ICD 11

As mentioned earlier in the section, for a chronic condition that is also intractable, use only code ME86.27 code to fully describe the condition. In ICD-10, a combination of G89.29 with M54.59 is used while in ICD-11, only code is enough to provide on the claim.

How To Code Low Back Pain With Radiculopathy

The following information is specifically written to help you decipher how to code low back pain with radiculopathy.

What Is Low Back Pain With Radiculopathy

Low back pain is normally associated with radiculopathy and is not mentioned when talking about radiculopathy. Radiculopathy is sometimes confused with sciatica but actually, it’s pinching or inflammation of nerves radiating in the spinal column. It can be in any spinal area mostly happening in the cervical spine.

ICD 10 Low Back Pain With Radiculopathy

Pain is not coded with radiculopathy as its integral component of the main diagnosis, looking for radiculopathy in the alphabetic index will lead to the M54 category. If the region of radiculopathy is unspecified, M54.10 for radiculopathy should be used. There are other codes for the lumbar, cervical and thoracic region to use when radiculopathy of those regions is provided in the assessment. The ICD 10 code for low back pain with radiculopathy is M54.10.

Chronic Low Back Pain With Radiculopathy ICD 10 Code

The Chronic Low Back Pain With Radiculopathy ICD 10 code is G89.29, M54.10. Low back pain is an essential component of radiculopathy and is not allowed to code with the M54.1 subcategory. Radiculopathy is coded as M54.10 when the area of disease is not defined; mostly M54.16 is assumed for low back pain with radiculopathy for the lumbar region. G89.29 for chronic pain can also be coded here; however, coding from M54.1 would also be sufficient.

Low Back Pain With Right Radiculopathy ICD 10

The Low Back Pain With Right Radiculopathy ICD 10 code is M54.10. Literality is not defined with a separate code in the radiculopathy main coding category. Radiculopathy mostly happens in the specific vertebral area, until the ICD 10 coding system provides new code sets for literality, only using code for radiculopathy from this category. Back pain will not be coded here as per coding guidelines.

Low Back Pain With Left Radiculopathy ICD 10

The Low Back Pain With Left Radiculopathy ICD 10 code is M54.10. Literality is not defined with a separate code in the radiculopathy main coding category. Radiculopathy mostly happens in the specific vertebral area, until the ICD 10 coding system provides new code sets for literality, only using code for radiculopathy from this category. Back pain will not be coded here as per coding guidelines.

Low Back Pain With Radiculopathy ICD 11 Code

The Low Back Pain With Radiculopathy ICD 11 Code is 8B93.Z. Low back pain has different stem codes and radiculopathy falls in a different category, ICD-11 has not provided any inclusion, exclusion notes, or matching relationship between these two stem codes. Coding both conditions would also be appropriate when both are mentioned in medical notes but taking a leaf from the ICD-10 edition, It would be more appropriate to only use 8B93.Z only for radiculopathy with manifestation extension code.

icd 10 low back pain with radiculopathy

How To Code Chronic Low Back Pain

The following information is specifically written to help you decipher how to code chronic low back pain.

What Is Chronic Low Back Pain?

Pain is acute when it’s short-term and can be treated by active care management but if that pain lasts longer than 3 months and require passive management of the condition then it becomes chronic pain. Chronic low back affects mostly people of older age or younger when facing some injury that has not resolved completely. Nerve injections and therapy services are the best modes of treatment for chronic back pain.

Chronic Low Back Pain ICD 10

The Chronic low back pain ICD 10 is G89.29 and M54.50. According to ICD-10 guidelines, if the pain is described as chronic, one code from the G89 category and then one code from the area of actual pain should be used. G89.29 should be used when the origin of the pain is unspecified. If chronic pain is not specifically described as a result of trauma but trauma or injury is mentioned in history, G89.21 would still be appropriate. M54.50, as the secondary diagnosis, should be coded.

Chronic Bilateral Low Back Pain With Bilateral Sciatica ICD 10

The chronic bilateral low back pain with bilateral sciatica ICD 10 is G89.29, M54.41, and M54.42. Low back pain is neither coded as separate code with sciatica nor with sciatic injury. G89.29 should be the primary diagnosis in this case as per guidelines, followed by M54.41 and M54.42 for the right, and left side of sciatica. M54 category does falls in exclude notes of G89 category but is allowed to code when conditions are specified in medical notes.

Chronic Low Back Pain With Radiculopathy ICD 10

According to CMS guidelines, a code for chronic pain G89.29 and radiculopathy from M54.1 should be used. Using M54.50 with M54.1 is not allowed, otherwise, payers will deny the claim. M54.10 is the choice of code when the further explanation of the region is not mentioned. The Chronic Low Back Pain With Radiculopathy ICD 10 code is G89.29 and M54.10.

Chronic Right Sided Low Back Pain ICD 10

The Chronic Right Sided Low Back Pain ICD 10 code is G89.29 and M54.50. No literality code is provided by the ICD-10 system, a further modification may provide new sets of code for the right and left side but currently, G89.29 and M54.50 are fulfilling the need of condition coding.

Chronic Left Sided Low Back Pain ICD 10

The same set of codes, G89.29 and M54.50, should be used for the left side of chronic low back pain. Using M54.59 “other specified low back pain” for literality is not allowed, as literality does not fall under NEC coding rule. The Chronic Left Sided Low Back Pain ICD 10 code is G89.29 and M54.50.

Chronic Low Back Pain In ICD 11

As ICD-11 came with new modifications, a code with chronic low back is one of the best combinations provided, as this term is one of the commonly used terms to fully describe a patient’s condition by medical providers. There are two codes available, one for chronic low back pain ME86.27 and the other for primary chronic low back pain MG30.02. If a condition is not described as the primary one, should use the code ME86.27 for other specified chronic pain. It is advised to use MG30.02 only if a chronic condition is described as the primary one. The ICD 11 code for chronic low back pain is MG30.02.

Chronic Bilateral Low Back Pain With Sciatica ICD 10

As per guidelines, there is no separate code to describe the left or right side of low back pain, only G89.29 should be used. In case when sciatica is defined with literality, using M54.40, would be appropriate. The ICD 10 code for chronic bilateral low back pain is G89.29 and M54.40

Acute Exacerbation Of Chronic Low Back Pain ICD 10

The acute exacerbation of chronic low back pain ICD 10 code is G89.29 and M54.50. When pain is mentioned as chronic, any exacerbation in pain would still be coded as chronic. There are separate codes for exacerbation of chronic conditions in other categories but G89.29 is the only available code whether the condition is exacerbated or not. G89.29 with M54.50 are our codes of choice here.

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