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v1.0.0
ICD-10 Guide
ICD-10 CodesM54.89

M54.89

Billable

Other dorsalgia

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

Code Description

ICD-10 M54.89 is a billable code used to indicate a diagnosis of other dorsalgia.

Key Diagnostic Point:

Dorsalgia refers to pain in the back region, which can arise from various underlying conditions affecting the spine, muscles, ligaments, or nerves. The term 'other dorsalgia' encompasses back pain that does not fit into more specific categories such as cervical or lumbar pain. Patients may experience symptoms ranging from mild discomfort to severe pain, which can be acute or chronic in nature. Common causes include muscle strain, degenerative disc disease, herniated discs, and conditions like sciatica, where nerve compression leads to pain radiating down the leg. Management of dorsalgia typically begins with conservative approaches, including physical therapy, pain medications, and lifestyle modifications. In cases where conservative treatment fails, surgical options may be considered, such as discectomy or spinal fusion. Accurate diagnosis and treatment planning are crucial, as the underlying cause of dorsalgia can significantly influence the management strategy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying conditions that can cause dorsalgia
  • Differentiation from other specific dorsalgia codes
  • Need for comprehensive documentation to support diagnosis
  • Potential for overlapping symptoms with other conditions

Audit Risk Factors

  • Insufficient documentation of the underlying cause of dorsalgia
  • Inconsistent use of the code across different providers
  • Failure to document conservative treatment attempts before surgical intervention
  • Misclassification of dorsalgia as a more specific code

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-surgical follow-ups, or acute injuries.

Billing Considerations

Ensure documentation reflects the specific nature of the dorsalgia and any associated conditions.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, treatment goals, and progress notes.

Common Clinical Scenarios

Rehabilitation following back surgery or chronic pain management.

Billing Considerations

Documenting the impact of dorsalgia on daily activities and quality of life is crucial.

Coding Guidelines

Inclusion Criteria

Use M54.89 When
  • According to ICD
  • 10 guidelines, M54
  • 89 should be used when dorsalgia does not fit into more specific categories
  • Coders must ensure that the diagnosis is supported by clinical documentation and that the patient's symptoms are clearly articulated

Exclusion Criteria

Do NOT use M54.89 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 must include the specific exercises performed and the patient's response.

Specialty Considerations

Physical therapists should document progress and any modifications to the treatment plan.

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. M54.89 serves as a catch-all for cases that do not fit into more defined categories, emphasizing the need for thorough documentation.

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. M54.89 serves as a catch-all for cases that do not fit into more defined categories, emphasizing the need for thorough documentation.

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. M54.89 serves as a catch-all for cases that do not fit into more defined categories, emphasizing the need for thorough documentation.

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 M54.89 instead of a more specific dorsalgia code?

M54.89 should be used when the back pain does not fit into a more specific category, and the documentation supports a diagnosis of 'other dorsalgia'.