Get The Lowdown On New Low Back Pain Codes : Diagnosis Deep Dive

low back pain icd 10

The provider lists both low back strain and back pain separately in the Assessment and Plan. Many more new diagnoses can be tracked using ICD-10 than with ICD-9. Some internet expanded code sets, like ICD-10-CM, have over 70,000 codes. The pain can vary from mild to severe or a dull, continuous ache to unanticipated sharp or shooting pain.

low back pain icd 10

Knowing your ICD-10-CM guidelines in section I.C.6.b for category G89 Pain, not elsewhere classified is crucial to accurately coding chronic LBP. Code M54.50 includes loin pain and low back pain (lumbago) not otherwise specified (NOS), M54.51 includes low back vertebral endplate pain, and you should use M54.59 more info for specified low back pain that’s not in the vertebrae. It’s very possible, especially at a first encounter, that the exact source of the pain won’t be known, which will likely lead to the unspecified code M54.50. When working in the primary care setting, there can be many instances of unspecified.

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When the documentation is not clear enough for correct coding, it’s time to query the provider. However, it’s important that your queries do not sway a provider to document a certain way. An Excludes2 note indicates that the excluded active condition is not part of the condition represented by the code; however, the patient may have both conditions at the same time. An exception to the Excludes1 designation is when two conditions are unrelated to each other.

That adds more emphasis on identifying the specifics of the LBP. The more specificity in the documentation, the more accurate the code selection will be. The Excludes1 designation indicates that the paired diagnoses should not be coded together. An Excludes1 designation is determined when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. If both complaints are documented, code the one listed in the Excludes1 note.

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Pain typically falls under acute or chronic, explains Maureen Leahey, CHC, CPC, primary care coding team leader with Sentara Healthcare in Norfolk, Virginia. With acute diagnoses, the cause is typically known, such as a car accident. It is ongoing and can influence functional or structural changes in the peripheral or central nervous systems, Leahey says. Four out of five individuals experience low back pain (LBP) at some point in their lives. LBP is a blanket term for acute or chronic pain caused by any number of things from disease or injury to activity or inactivity. The provider must be able to identify the cause of the LBP before you can submit a more specific code.

For these new additions, the more details, the better for more accurate coding and fewer reasons for denial. If the provider has images confirming degenerative disc disease, spinal stenosis, or a herniated disc, for example, these would be better [diagnosis] options to use since the condition would be the cause of the pain, says Leahey. Per the Excludes1 note, some lumbago is classified elsewhere, Moore points out. Lumbago is a general term often used for pain in the lower back, so you should pay attention to the patient record carefully, and query the provider if questions arise. Additionally, note that lumbago NOS is the only lumbago coded to M54.50, says Moore.

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