M54.5: Low Back Pain

Non-Billable/Non-Specific Code:

M54.5 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.

Clinical Information:

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.

Approximate Synonyms:

• Acute low back pain
• Acute low back pain for less than 3 months
• Acute low back pain less than 3 months
• Chronic low back pain
• Chronic low back pain for greater than 3 months
• Chronic low back pain greater than 3 months
• Chronic low back pain greater than 3 months duration
• Low back pain for less than 3 months
• Low back pain for less than 6 months
• Low back pain in pregnancy
• Low back pain less than 3 months
• Low back pain less than 6 months
• Low back pain without radiculopathy
• Lumbar back pain acute,
• Mechanical low back pain
• Pain of lumbar, acute, for less then 3 months

ICD-10: A Brief Synopsis

For disease reporting, the US utilizes its own national variant of ICD-10 called the ICD-10 Clinical Modification (ICD-10-CM). A procedural classification called ICD-10 Procedure Coding System (ICD-10-PCS) has also been developed for capturing inpatient procedures. The ICD-10-CM and ICD-10-PCS were developed by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). There are over 70,000 ICD-10-PCS procedure codes and over 69,000 ICD-10-CM diagnosis codes, compared to about 3,800 procedure codes and roughly 14,000 diagnosis codes found in the previous ICD-9-CM.

The expansion of healthcare delivery systems and changes in global health trends prompted a need for codes with improved clinical accuracy and specificity. The alphanumeric coding in ICD-10 is an improvement from ICD-9 which had a limited number of codes and a restrictive structure. Early concerns in the implementation of ICD-10 included the cost and the availability of resources for training healthcare workers and professional coders.

There was much controversy when the transition from the ICD-9-CM to the ICD-10-CM was first announced in the US. Many providers were concerned about the vast number of codes being added, the complexity of the new coding system, and the costs associated with the transition. The Centers for Medicare and Medicaid Services (CMS) weighed these concerns against the benefits of having more accurate data collection, clearer documentation of diagnoses and procedures, and more accurate claims processing. CMS decided the financial and public health cost associated with continuing to use the ICD-9-CM was too high and mandated the switch to ICD-10-CM.