Clinical Overview
Low back pain (LBP) is a common clinical condition characterized by discomfort or pain localized between the lower rib margin and the gluteal folds. It can be classified as acute, subacute, or chronic, and often stems from musculoskeletal issues, degenerative disc disease, or nerve root compression.
Suggested ICD-10 Codes
- M54.50: Low back pain, unspecified
- M54.51: Vertebrogenic low back pain
- M54.5: Other low back pain
M54.50: Low back pain, unspecified | Billable
This code represents a clinical diagnosis for pain localized to the lumbar region of the spine when the documentation does not provide a more specific underlying cause or anatomical site.
Detailed Description for M54.50
Low back pain (LBP) is a common musculoskeletal symptom characterized by pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain. Code M54.50 is used when the provider documents ‘low back pain’ or ‘lumbago’ without further specification of the etiology, such as disc displacement, radiculopathy, or spondylosis. It is often utilized during initial patient encounters or when a definitive diagnosis is pending further diagnostic imaging or clinical evaluation. If the pain is associated with sciatica, clinicians should instead refer to the M54.4 series. For chronic low back pain specifically, M54.51 may be more appropriate if documented as such. Documentation should ideally specify the duration (acute, subacute, or chronic) and any associated neurological findings to ensure the highest level of coding specificity.
Clinical Information for M54.50
Low back pain is one of the most frequent reasons for physician visits and can range from acute to chronic. When coding for low back pain, it is important to distinguish between non-specific pain and pain associated with specific anatomical findings. M54.50 should be used as a primary diagnosis only when a more definitive diagnosis cannot be made. If the pain is associated with sciatica, code M54.4- should be used instead. Documentation should ideally specify the duration and any associated symptoms to assist in more granular coding if possible. If the pain is the result of a specific injury or strain, codes from the S39 category may be more appropriate.
Includes
Loin pain, Lumbago NOS
Excludes
lumbago due to intervertebral disc displacement (M51.2-), lumbago with sciatica (M54.4-), low back strain (S39.012)
M54.51: Vertebrogenic low back pain | Billable
Detailed Description for M54.51
ICD-10-CM code M54.51 is used to report vertebrogenic low back pain. This specific diagnosis identifies chronic low back pain that originates from the vertebral endplates rather than the intervertebral discs themselves. The pain is typically associated with degenerative changes in the vertebral bodies, specifically at the interface between the disc and the bone. This condition is often identified through magnetic resonance imaging (MRI) showing Modic changes, which represent inflammatory or fibrovascular changes in the bone marrow of the vertebral bodies adjacent to a degenerated disc.
Clinical Information for M54.51
Vertebrogenic pain is a distinct clinical phenotype of chronic low back pain. It is mediated by the basivertebral nerve (BVN), which innervates the vertebral endplates. Clinicians use this code when there is evidence of endplate-mediated pain, often confirmed by Modic Type 1 or Type 2 changes on MRI at the L3 to S1 levels. Distinguishing vertebrogenic pain from other types of back pain, such as discogenic or radicular pain, is crucial for determining appropriate interventions, such as basivertebral nerve ablation.
Includes
Low back pain due to vertebral endplate changes
Excludes1
low back pain NOS (M54.50), lumbago with sciatica (M54.4-), psychogenic lumbago (F45.8), spondylolisthesis (M43.1-)
M54.59: Other low back pain | Billable
Detailed Description for M54.59
ICD-10-CM code M54.59 is a specific medical code used to classify ‘Other low back pain.’ This code was implemented in October 2021 as part of the 2022 update to provide more specificity than the previously used M54.5. It represents pain located in the lumbar region of the spine that is not further specified as lumbago with sciatica or caused by specific conditions like intervertebral disc disorders. It is typically used when a patient presents with generalized pain in the lower back area without a more definitive underlying diagnosis being documented at the time of the encounter.
Clinical Information for M54.59
Low back pain is one of the most common reasons for patient visits to primary care and emergency departments. Clinicians use M54.59 for non-specific mechanical low back pain or when the exact etiology of the lumbar pain is not yet determined. It is important for coders to distinguish this from M54.50 (Low back pain, unspecified) and M54.51 (Vertebrogenic low back pain). If the pain is associated with sciatica, the M54.4- series should be used instead. Documentation should ideally specify the site, nature, and any associated symptoms to ensure the most accurate code selection.
Includes
Lumbago NOS
Excludes
lumbago due to intervertebral disc displacement (M51.2-), lumbago with sciatica (M54.4-), low back strain (S39.012), psychogenic lumbago (F45.8)
