Back Pain ICD 10 Codes (2021)

Chronic back pain (LBP) is one of the most common disability causes among US adults under 45, and 10% to 20% of American workers report persistent back pain. When back pain disappears with rest, home remedies or medical treatments may become necessary, such as over-the-counter painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Epidural Steroid injections are a mainstay in pain management and the treatment of painful sciatica.

Causes Of Back Pain

Back pain is a symptom of many different diseases and conditions. In many cases, the doctors cannot find the cause of the pain. The main cause of back pain may be a problem with the back itself or a problem with another part of the body. Degenerative arthritis is a wear and tear process associated with age, injury or genetic predisposition. Infection of intervertebral disc space between bones (osteomyelitis) in the abdomen or pelvis or the bloodstream.

The upper back consists of the thoracic spine and bony structures, the so-called vertebrae, which are surrounded by nerves and spinal cords. Between these structures are spongy cartilage sacs, the so-called intervertebral discs which act as cushions and provide freedom of movement in the back. Additional support to the muscle, tendons and ligaments is provided. The structure of the back can become inflamed or irritated in response to a variety of mild to severe diseases. The most common causes are mild to severe back pain due to sudden movements, sports activities and DIY projects in the upper back.

Upper back pain can also be caused by more serious conditions such as fibromyalgia, spondylitis (a type of spinal arthritis) and herniated discs. The lower back is a hotspot for bulging or herniated discs, and the intervertebral discs in the upper back can deteriorate or tear. A bulging intervertebral disc can put pressure on nerves and roots coming from the spine, causing pain in the upper back. Problems with another part of the body such as the heart can also radiate from the lower back. This is known as upper back pain.

Upper back pain can become chronic and overwhelming. Physical therapy, basic self-help measures and the adherence to the treatment plan designed by your doctor can help treat the many causes of back pain and relieve it. Ask your doctor in advance about treating the back pain if you have problems. Most cases of back pain are not caused by a serious illness and do not lead to long-term complications. The complications associated with this type of back pain depend on the underlying disease, disorder or disease

Guidelines For Back Pain ICD 10 CM

The guidelines for ICD 10 CM states that if the cause of pain is known, the code is assigned to the underlying diagnosis, not the pain code if the cause is known. For example, if we encode lumbar radiculopathy as M5416, you can not assign M545 (lumbar pain) to this code. Although we report Radicullopathy as an ICD 10 code, we do not report the code for back pain.

The ICD 10 code M545 is used to specify conditions associated with acute back pain (C & O lumbar pain, C & O back pain or chronic back pain) or complaints about back pain or facet or joint pain. This code is used in general practice, internal medicine and orthopaedic specialties to define clinical concepts such as neck pain. Like the billable ICD 10 code, M545 is also used for medical diagnosis and reimbursement of chronic back pain.

List Of Back Pain ICD 10 CM Codes

Acute and chronic back pain (LBP) are encoded with the same ICD 10 code (M545) in the electronic health record and distinguished by retrospective chart verification. This hinders efficient definition and data-driven guidelines for billing and therapy recommendations such as returning to work. Acute and chronic back pain are different diseases with different treatment options.

M54: Dorsalgia

M540: Panniculitis affecting regions of neck and back

M5400: Site unspecified.
M54.01: Occipito-atlanto-axial region.
M54.02: Cervical region.
Cervicothoracic region.
M54.04: Thoracic region.
M54.05: Thoracolumbar region.
M54.06: Lumbar region.
Lumbosacral region.
M54.08: Sacral and sacrococcygeal region.
M54.09: Panniculitis affecting regions, neck and back, multiple sites in spine.

M541: Radiculopathy

M54.10: Site unspecified.
M54.11: Occipito-atlanto-axial region.
M54.12: Cervical region.
M54.13: Cervicothoracic region.
M54.14: Thoracic region.
M54.15: Thoracolumbar region.
M54.16: Lumbar region.
M54.17: Lumbosacral region.
M54.18: Sacral and sacrococcygeal region

M542: Cervicalgia

M543: Sciatica

M54.30: Unspecified side.
M54.31: Right side.
M54.32: Left side.

M544: Lumbago with sciatica

M54.40: Unspecified side.
M54.41: Right side.
M54.42: Left side.

M545: Low back pain

M546: Pain in thoracic spine

M548: Other Dorsalgia

M54.81: Occipital neuralgia.
M54.82: Other dorsalgia.

M549: Dorsalgia unspecified

Back Pain ICD 10 Examples

Lauryn is a 31-year-old woman who goes to her doctor with acute chest pains. The doctor suspects thoracic spinal stenosis and orders an MRI of the spine. This code is the appropriate ICD-10cm code for the scenario above.

ICD 10 Codes: M54.6 (Thoracic spinal stenosis is not coded as this is a suspected condition)

Henk (44-year-old male patient) comes in to the clinic with a steroid injection for pain because of his pain. The patient is in pain because of trauma he had a few years ago.

ICD 10 Codes: G89.21, M54.5

Ella is a 78-year-old woman suffering from senile osteoporosis. She complains of severe lower back pain and has no trauma. An X-ray of the spine shows pathological compression fractures of the vertebrae L3 and L4.

ICD 10 Codes: M80.08XA

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