ICD-10 Code M54.50: Low Back Pain

The ICD-10-CM is a standardized code set that serves as the medium for documentation of diagnoses, symptoms, and medical conditions within the United States healthcare system. These alphanumeric codes act as a common language between providers, payers, and government agencies, ensuring the accurate flow of information for appropriate reimbursement and meaningful data collection around health issues.

Understanding the ICD-10 Code M54.50

M54.50 – Low Back Pain is one of the most commonly used diagnostic codes for clinical purposes among the thousands of ICD-10-CM codes available.

Why ICD-10 M54.50 Matters

Clinical Significance: Proper coding ensures appropriate treatment of pathways and resource allocation.

Documentation: Essential for tracking patient outcomes and population health trends.

ICD-10 Code M54.50 is essential for healthcare professionals, medical coders, and billing specialists involved in managing musculoskeletal conditions. This code provides the specificity needed for accurate diagnosis of documentation, appropriate treatment pathways, and proper reimbursement while capturing the diverse presentations of low back pain.

Code Classification

M54.50 – Low back pain

Category: Dorsalgia (M54)

Chapter: Diseases of the musculoskeletal system and connective tissue (M00-M99)

Block: Dorsopathies (M40-M54)

Key Details

Billable/Specific: Yes, this is a billable code that can be used for reimbursement

ICD-9-CM Equivalent: 724.2 (Lumbago)

Effective Date: October 1, 2015 (when ICD-10 was implemented)

Clinical Description

M54.5 covers low back pain, which includes:

Lumbago – the medical term for lower back pain

Pain localized to the lumbar region of the spine

Both acute and chronic presentations

Mechanical and non-specific low back pain

Important Coding Notes

Includes:

Pain in the lumbar region

Lumbago NOS (not otherwise specified)

Both acute and chronic low back pain

Excludes:

Low back strain (S39.012) acute injury codes

Sciatica (M54.3) when pain radiates down the leg

Postural kyphosis (M40.0)

Psychogenic Dorsalgia (F45.41)

Clinical Context

Low back pain is one of the most common reasons for medical visits and disability claims. The M54.50 code is used when:

The pain is primarily in the lower back/lumbar region.

No specific underlying pathology is identified.

The condition doesn’t meet criteria for more specific diagnoses.

Documentation Requirements

For proper coding, medical documentation should include:

Location of pain (lumbar/lower back)

Duration (acute vs. chronic)

Any associated symptoms

Exclusion of radicular symptoms (which would suggest sciatica)

Related Codes to Consider

M54.3: Sciatica (when pain radiates to leg)

M54.2: Cervicalgia (neck pain)

M54.6: Pain in thoracic spine

S39.012: Strain of muscle, fascia and tendon of lower back

Accurate use of M54.50 supports continuity of care, enables effective population health tracking, and facilitates evidence-based treatment protocols for low back pain patients.

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