2025 ICD-10-CM code M54.5
(Active) Effective Date: N/A Revision Date: N/A Dorsopathies - Other dorsopathies (M50-M54) Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Low back pain, not otherwise specified.
Modifiers may be applicable depending on the specific services provided and the context of the encounter. Consult current coding guidelines for appropriate modifier use.
Medical necessity for treatment of low back pain is established when the condition significantly impairs the patient's functional abilities and daily life activities. The necessity of specific diagnostic or therapeutic interventions must be documented based on the findings of the history and physical examination, imaging studies, and any other diagnostic testing.Conservative treatments are generally considered first-line options, and surgical intervention may be medically necessary only after conservative options have been tried and failed or when a serious underlying condition is present.
Diagnosis and management of low back pain involves a thorough history and physical examination to determine the cause and severity of the pain. This may include assessing range of motion, muscle strength, reflexes, and neurological function. Imaging studies such as X-rays or MRI may be ordered to visualize the spine and surrounding structures.Further diagnostic tests like electromyography (EMG) and nerve conduction studies (NCS) may be necessary to evaluate nerve damage. Treatment plans vary depending on the diagnosis and may involve conservative management (rest, pain medication, physical therapy, injections) or surgical intervention if necessary.The clinical responsibility of managing low back pain can fall under various specialists depending on the specific cause and complexity of the condition, including primary care physicians, orthopedists, neurologists, neurosurgeons, and physiatrists.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Dorsopathies (M40-M54) > Other dorsopathies (M50-M54)
In simple words: Low back pain is pain in your lower back. It can feel like an ache, sharp pain, or burning. It can be mild or severe, and may last for a short time or be long-lasting.Many things can cause it, like muscle strains, arthritis, or problems with your spine. Doctors diagnose it by asking about your symptoms, examining you, and maybe doing tests like X-rays or MRIs. Treatment often involves rest, gentle exercise, heat or ice, and sometimes medicine.
Low back pain (LBP) is pain located in the lower region of the back, between the lower ribs and the buttocks.It can manifest as a dull ache, sharp pain, or a combination, and may radiate to other areas such as the legs (sciatica). The pain can be acute (lasting under 6 weeks), subacute (6-12 weeks), or chronic (over 12 weeks).Causes can be diverse, ranging from muscle strains and sprains to more serious conditions like spinal fractures, arthritis (osteoarthritis, ankylosing spondylitis), spinal stenosis, spondylolisthesis, tumors, or infections.Diagnosis involves patient history, physical examination (assessing range of motion, strength, reflexes), imaging (X-ray, MRI), and potentially electromyography/nerve conduction studies. Treatment may involve conservative measures (rest, heat/cold therapy, exercise, massage), medications (NSAIDs), and addressing any underlying causes.
Example 1: A 35-year-old female presents with acute low back pain after lifting a heavy box. Physical examination reveals muscle spasms and limited range of motion.Diagnosis: Muscle strain. Treatment: Rest, ice, over-the-counter analgesics, and physical therapy., A 60-year-old male with a history of osteoarthritis reports chronic low back pain radiating down his right leg (sciatica). MRI reveals a herniated disc at L4-L5. Diagnosis: Lumbar disc herniation. Treatment:Conservative management with pain medication and physical therapy initially. Surgery may be considered if conservative treatment fails., A 70-year-old female presents with severe low back pain and progressive weakness in her legs.Neurological exam reveals decreased reflexes and sensory loss. MRI demonstrates spinal stenosis. Diagnosis: Spinal stenosis. Treatment: Surgical decompression and fusion.
Detailed patient history including onset, location, character, and duration of pain; aggravating and alleviating factors; relevant past medical history; and any history of trauma.Results of physical examination including range of motion, muscle strength, reflexes, and neurological findings.Imaging reports (X-rays, MRI, CT) with specific findings.Electromyography (EMG) and nerve conduction study (NCS) reports if performed.Treatment plan and rationale.Response to treatment.
** This code should only be used when the underlying cause of low back pain is not specified or is not otherwise classifiable.Always document the clinical details comprehensively to support the coding selection.
- Payment Status: Active
- Specialties:Primary Care, Orthopedics, Neurosurgery, Neurology, Physiatry, Rheumatology
- Place of Service:Office, Hospital (Inpatient, Outpatient), Urgent Care Facility, Ambulatory Surgical Center