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v1.0.0
ICD-10 Guide
ICD-10 CodesM54.59

M54.59

Billable

Other low back pain

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M54.59 is a billable code used to indicate a diagnosis of other low back pain.

Key Diagnostic Point:

M54.59 refers to 'Other low back pain,' which encompasses various forms of low back discomfort not classified under more specific codes. This condition can arise from multiple etiologies, including muscular strain, ligamentous injury, degenerative disc disease, or other underlying pathologies. Patients may present with symptoms ranging from mild discomfort to severe pain that can radiate to the lower extremities, potentially mimicking sciatica. The pain may be acute or chronic, and its management often involves a multidisciplinary approach. Conservative treatment options typically include physical therapy, analgesics, and lifestyle modifications, while surgical interventions may be considered for cases that do not respond to conservative measures or when there is significant neurological compromise. Accurate diagnosis and documentation are crucial, as they guide treatment decisions and coding accuracy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to low back pain.
  • Differentiation from other specific low back pain codes.
  • Need for thorough documentation to support the diagnosis.
  • Variability in treatment approaches and patient responses.

Audit Risk Factors

  • Inadequate documentation of the pain's duration and severity.
  • Failure to specify the underlying cause of the low back pain.
  • Misuse of the code when a more specific diagnosis is applicable.
  • Inconsistent treatment documentation that does not match the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of the patient's condition, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic low back pain, post-surgical pain, or pain following trauma.

Billing Considerations

Documentation must clearly outline the rationale for surgical intervention if pursued.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations, treatment goals, and progress notes.

Common Clinical Scenarios

Patients undergoing rehabilitation for low back pain due to injury or surgery.

Billing Considerations

Focus on functional outcomes and the impact of pain on daily activities.

Coding Guidelines

Inclusion Criteria

Use M54.59 When
  • According to ICD
  • 10 guidelines, M54
  • 59 should be used when the low back pain does not fit into more specific categories
  • Coders must ensure that the documentation supports the diagnosis and that the pain is not attributable to a more specific condition

Exclusion Criteria

Do NOT use M54.59 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97110CPT Code

Therapeutic exercises

Clinical Scenario

Used for patients undergoing rehabilitation for low back pain.

Documentation Requirements

Documentation must include the type of exercises performed and the patient's response.

Specialty Considerations

Physical therapists should document progress towards functional goals.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of low back pain, improving the ability to capture the complexity of the condition and its management. M54.59 provides a broader classification that can encompass various presentations of low back pain, allowing for better tracking of treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of low back pain, improving the ability to capture the complexity of the condition and its management. M54.59 provides a broader classification that can encompass various presentations of low back pain, allowing for better tracking of treatment outcomes.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

When should I use M54.59 instead of M54.5?

M54.59 should be used when the low back pain does not fit into the more specific category of M54.5, which is for unspecified low back pain. If there are identifiable factors contributing to the pain that do not fall under other specific codes, M54.59 is appropriate.