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v1.0.0
ICD-10 Guide
ICD-10 CodesM54.8

M54.8

Billable

Other dorsalgia

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

Code Description

ICD-10 M54.8 is a billable code used to indicate a diagnosis of other dorsalgia.

Key Diagnostic Point:

M54.8 refers to 'Other dorsalgia,' which encompasses various types of back pain not classified elsewhere in the ICD-10 coding system. Dorsalgia is a term used to describe pain in the back region, which can arise from a multitude of causes including muscle strain, ligament sprain, herniated discs, degenerative disc disease, or other underlying conditions. Patients may present with localized pain, radiating pain, or a combination of both, often accompanied by stiffness or reduced mobility. Sciatica, characterized by pain radiating along the sciatic nerve, may also fall under this category if it does not fit more specific codes. Management of dorsalgia typically begins with conservative approaches such as physical therapy, medication, and lifestyle modifications. In cases where conservative treatment fails, surgical options may be considered, particularly for conditions like herniated discs or spinal stenosis. Accurate coding is essential for proper treatment reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to dorsalgia
  • Overlap with other specific dorsalgia codes
  • Need for detailed clinical documentation to justify the diagnosis
  • Potential for misclassification with more specific codes

Audit Risk Factors

  • Inadequate documentation of the specific type of dorsalgia
  • Failure to link the diagnosis to treatment provided
  • Misuse of M54.8 when a more specific code is applicable
  • Lack of evidence for conservative management attempts before surgical intervention

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of present illness, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic back pain, post-operative follow-ups, or evaluations for surgical candidacy.

Billing Considerations

Ensure clarity in documentation regarding the specific nature of the dorsalgia and any associated neurological symptoms.

Physical Medicine and Rehabilitation

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation for patients recovering from back injuries or surgeries, and management of chronic pain syndromes.

Billing Considerations

Document the multidisciplinary approach to treatment and the patient's response to conservative management.

Coding Guidelines

Inclusion Criteria

Use M54.8 When
  • According to ICD
  • 10 guidelines, M54
  • 8 should be used when dorsalgia does not fit into more specific categories
  • Coders must ensure that the documentation supports the diagnosis and that the condition is not due to a more specific underlying pathology

Exclusion Criteria

Do NOT use M54.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97110CPT Code

Therapeutic exercises

Clinical Scenario

Used for patients undergoing physical therapy for dorsalgia.

Documentation Requirements

Documentation of the patient's functional limitations and progress notes.

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 dorsalgia, improving the ability to capture the complexity of back pain conditions. M54.8 serves as a catch-all for various nonspecific back pain cases, which can help in understanding treatment patterns and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of dorsalgia, improving the ability to capture the complexity of back pain conditions. M54.8 serves as a catch-all for various nonspecific back pain cases, which can help in understanding treatment patterns and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of dorsalgia, improving the ability to capture the complexity of back pain conditions. M54.8 serves as a catch-all for various nonspecific back pain cases, which can help in understanding treatment patterns and outcomes.

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 M54.8 instead of a more specific dorsalgia code?

M54.8 should be used when the dorsalgia does not fit into a more specific category or when the underlying cause is unknown. Ensure that documentation supports the use of this code.