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v1.0.0
ICD-10 Guide
ICD-10 CodesM54.6

M54.6

Billable

Pain in thoracic spine

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

Code Description

ICD-10 M54.6 is a billable code used to indicate a diagnosis of pain in thoracic spine.

Key Diagnostic Point:

Pain in the thoracic spine, classified under M54.6, refers to discomfort or pain localized in the middle section of the back, which can arise from various underlying causes. This condition may result from muscular strain, degenerative disc disease, herniated discs, or trauma. Patients often describe the pain as sharp, dull, or aching, and it may radiate to other areas, including the shoulders or abdomen. The thoracic spine consists of 12 vertebrae, and pain in this region can significantly impact mobility and quality of life. Diagnosis typically involves a thorough clinical evaluation, including a physical examination and imaging studies such as X-rays or MRIs to identify any structural abnormalities. Treatment options vary widely and may include conservative management such as physical therapy, pain medications, and lifestyle modifications. In more severe cases, surgical interventions may be necessary to address underlying issues such as spinal stenosis or herniated discs. Understanding the multifactorial nature of thoracic spine pain is crucial for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes (muscular, neurological, structural)
  • Differentiation from other types of back pain (cervical, lumbar)
  • Need for precise documentation of pain characteristics and duration
  • Variability in treatment approaches (conservative vs. surgical)

Audit Risk Factors

  • Inadequate documentation of pain severity and duration
  • Failure to specify the underlying cause of pain
  • Misclassification of thoracic pain as cervical or lumbar
  • Lack of supporting imaging or clinical notes

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with thoracic pain after trauma, degenerative changes, or post-surgical complications.

Billing Considerations

Ensure documentation reflects the specific nature of the thoracic pain and any associated neurological symptoms.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments including functional limitations and response to therapy.

Common Clinical Scenarios

Rehabilitation following thoracic spine surgery or chronic pain management.

Billing Considerations

Documenting progress and response to conservative treatments is crucial for coding.

Coding Guidelines

Inclusion Criteria

Use M54.6 When
  • According to ICD
  • 10 guidelines, M54
  • 6 should be used when the primary complaint is pain in the thoracic spine without a more specific diagnosis
  • Coders must ensure that the documentation supports the diagnosis and that any underlying conditions are also coded appropriately

Exclusion Criteria

Do NOT use M54.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97110CPT Code

Therapeutic exercises

Clinical Scenario

Used in conjunction with M54.6 for rehabilitation.

Documentation Requirements

Documentation of the patient's functional limitations and progress.

Specialty Considerations

Physical therapists should document the specific exercises and patient response.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of thoracic spine pain, enabling better tracking of treatment outcomes and resource allocation. M54.6 provides a clear designation for thoracic pain, facilitating improved patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of thoracic spine pain, enabling better tracking of treatment outcomes and resource allocation. M54.6 provides a clear designation for thoracic pain, facilitating improved patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of thoracic spine pain, enabling better tracking of treatment outcomes and resource allocation. M54.6 provides a clear designation for thoracic pain, facilitating improved patient management.

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

What are the common causes of thoracic spine pain?

Common causes include muscular strain, degenerative disc disease, herniated discs, trauma, and systemic conditions such as osteoporosis.

How is thoracic spine pain diagnosed?

Diagnosis typically involves a thorough clinical evaluation, including patient history, physical examination, and imaging studies like X-rays or MRIs.

What treatment options are available for thoracic spine pain?

Treatment options range from conservative management, such as physical therapy and medications, to surgical interventions for structural issues.