ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM53.80

M53.80

Billable

Other specified dorsopathies, site unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED08/28/2025

Code Description

ICD-10 M53.80 is a billable code used to indicate a diagnosis of other specified dorsopathies, site unspecified.

Key Diagnostic Point:

Other specified dorsopathies, site unspecified

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity
### ICD-10 Code Analysis: M53.80 - Other Specified Dorsopathies, Site Unspecified #### 1) Complexity Rating: **Medium** - The complexity of coding M53.80 is rated as medium due to the need for precise documentation to differentiate it from other dorsopathies and to ensure appropriate reimbursement. The unspecified nature of the site may lead to ambiguity in clinical scenarios. #### 2) Documentation Requirements: - **Clinical Documentation**: Detailed patient history, including onset, duration, and characteristics of symptoms (e.g., pain, stiffness). - **Physical Examination Findings**: Specific observations related to the spine or back, including range of motion, tenderness, and neurological assessments. - **Diagnostic Tests**: Results from imaging studies (e.g., X-rays, MRIs) or other diagnostic procedures that support the diagnosis of dorsopathy. - **Treatment Plans**: Documentation of any treatments provided, including medications, physical therapy, or referrals to specialists. - **Follow-Up Notes**: Records of patient follow-up visits to track progress and response to treatment. #### 3) Clinical Considerations: - **Differential Diagnosis**: Consideration of other potential causes of back pain or dorsopathy, such as herniated discs, degenerative disc disease, or spinal stenosis. - **Patient Demographics**: Age, occupational history, and lifestyle factors that may contribute to dorsopathy. - **Comorbid Conditions**: Assessment of any existing conditions (e.g., obesity, osteoporosis) that may complicate the dorsopathy or influence treatment options. - **Treatment Response**: Monitoring and documenting the effectiveness of interventions to support ongoing care decisions. #### 4) Audit Risk Factors: - **Unspecified Site**: The use of "site unspecified" can raise flags during audits, as it may suggest insufficient documentation or lack of thorough clinical evaluation. - **Lack of Specificity**: Failure to provide detailed clinical information may lead to denials or requests for additional documentation. - **Inconsistent Coding**: Variability in coding practices among providers can lead to discrepancies in reported data, increasing audit scrutiny. - **Inadequate Follow-Up**: Insufficient documentation of follow-up care may indicate a lack of ongoing management, raising concerns about the quality of care. #### 5) Coding Best Practices: - **Use Specific Codes When Available**: Always strive to use the most specific code available to accurately reflect the patient's condition and avoid unspecified codes when possible. - **Thorough Documentation**: Ensure comprehensive documentation that supports the diagnosis and justifies the use of M53.80. - **Regular Training**: Engage in ongoing education for coding staff to stay updated on coding guidelines and best practices. - **Collaboration with Clinicians**: Work closely with healthcare providers to ensure that clinical notes are detailed and reflect the complexity of the patient’s condition. - **Review and Audit**: Implement regular internal audits of coding practices to identify areas for improvement and ensure compliance with coding standards. By adhering to these guidelines, healthcare professionals can ensure accurate coding, appropriate reimbursement, and high-quality patient care while minimizing audit risks.

Specialty Focus

Medical Specialties

### Medical Specialties Related to ICD-10 Code M53.80: Other Specified Dorsopathies, Site Unspecified **1. Primary Specialty:** - **Orthopedic Surgery (40%)** - Orthopedic surgeons frequently encounter patients with dorsopathies, particularly those involving the spine and musculoskeletal system. They may address conditions such as degenerative disc disease, spinal stenosis, or other unspecified dorsopathies that do not have a clear diagnosis. **2. Secondary Specialties:** - **Physical Medicine and Rehabilitation (PM&R) (25%)** - Specialists in PM&R, also known as physiatrists, focus on restoring function and improving quality of life for patients with musculoskeletal disorders, including dorsopathies. - **Neurology (15%)** - Neurologists may be involved in diagnosing and managing dorsopathies that have neurological implications, such as radiculopathy or myelopathy. - **Rheumatology (10%)** - Rheumatologists may treat dorsopathies related to autoimmune conditions, such as ankylosing spondylitis or other inflammatory disorders affecting the spine. - **Pain Management (10%)** - Pain management specialists often treat patients with chronic pain resulting from unspecified dorsopathies, utilizing various interventional and non-interventional techniques. **3. Documentation Requirements:** - **Comprehensive Patient History:** - Detailed history of present illness, including onset, duration, and characteristics of symptoms. - Review of past medical history, including any previous spinal surgeries or treatments. - **Physical Examination:** - Thorough musculoskeletal and neurological examination to assess range of motion, strength, reflexes, and sensory function. - **Diagnostic Imaging:** - Results from X-rays, MRI, or CT scans to rule out specific conditions or to support the diagnosis of unspecified dorsopathies. - **Treatment Plan:** - Document the rationale for treatment options, including conservative management (physical therapy, medications) or surgical interventions. - **Follow-Up:** - Regular documentation of patient progress and response to treatment, including any changes in symptoms or functional status. **4. Clinical Scenarios:** - **Scenario 1: Chronic Back Pain** - A 45-year-old patient presents with chronic lower back pain without a clear diagnosis. After a thorough evaluation, the physician documents unspecified dorsopathy (M53.80) as the diagnosis, and a treatment plan involving physical therapy and pain management is initiated. - **Scenario 2: Post-Surgical Complications** - A patient with a history of spinal surgery develops new-onset back pain and limited mobility. The orthopedic surgeon evaluates the patient and documents M53.80 due to complications related to the previous surgery, leading to a tailored rehabilitation program. - **Scenario 3: Neuropathic Symptoms** - A patient reports radiating pain and numbness in the lower extremities. The neurologist assesses the patient and, after ruling out specific conditions, assigns M53.80, focusing on managing neuropathic pain and improving function. **5. Specialty Considerations:** - **Orthopedic Considerations:** - Surgeons should consider the potential need for surgical intervention if conservative measures fail. Accurate coding is essential for reimbursement and tracking outcomes. - **PM&R Considerations:** - Rehabilitation specialists should focus on functional outcomes and may utilize multidisciplinary approaches, including occupational therapy and pain management. - **Neurology Considerations:** - Neurologists must differentiate between primary dorsopathies and those with neurological involvement, ensuring proper coding for associated conditions. - **Rheumatology Considerations:** - Rheumatologists should investigate underlying systemic conditions that may contribute to dorsopathy, ensuring comprehensive management and documentation. - **Pain Management Considerations:** - Pain specialists should document the impact of dorsopathy on the patient's quality of life and functional status, as this can influence treatment decisions and coding accuracy. ### Conclusion Understanding the implications of ICD-10 code M53.80 is crucial for healthcare professionals across various specialties. Accurate documentation, appropriate coding, and a comprehensive treatment approach are essential for optimal patient care and effective management of unspecified dorsopathies.

Coding Guidelines

Inclusion Criteria

Use M53.80 When
  • 10 Code: M53
  • Other Specified Dorsopathies, Site Unspecified
  • 1) Inclusion Criteria
  • This code is used to classify dorsopathies that do not fall under more specific categories within the dorsopathy classification
  • Conditions that may be coded under M53
  • 80 include:
  • Unspecified back pain
  • Other specified disorders of the spine that do not have a clear anatomical site

Exclusion Criteria

Do NOT use M53.80 When
  • 2) Exclusion Notes

Related ICD-10 Codes

Related CPT Codes

### CPT Codes for ICD-10 M53.80 (Other Specified Dorsopathies, Site Unspecified) #### 1) Lab/Diagnostic Procedures While there are no specific lab tests directly associated with M53.80, the following CPT codes may be relevant for diagnostic imaging and evaluation of dorsopathies: - **72148** - MRI, spinal canal and contents, lumbar; without contrast material - **72149** - MRI, spinal canal and contents, lumbar; with contrast material - **72150** - MRI, spinal canal and contents, lumbar; without and with contrast material - **72040** - X-ray, spine, 2 or 3 views, cervical - **72050** - X-ray, spine, 2 or 3 views, thoracic - **72070** - X-ray, spine, 2 or 3 views, lumbar #### 2) Treatment Procedures Treatment for dorsopathies may include physical therapy, injections, or surgical interventions. Relevant CPT codes include: - **97110** - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility (per 15 minutes) - **97112** - Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception (per 15 minutes) - **20610** - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., lumbar epidural steroid injection) - **63030** - Laminectomy, facetectomy, and foraminotomy, lumbar, single vertebral level (if surgical intervention is required) #### 3) Follow-Up Codes Follow-up visits for monitoring the condition may utilize the following CPT codes: - **99213** - Established patient office visit, low to moderate complexity - **99214** - Established patient office visit, moderate complexity - **99215** - Established patient office visit, high complexity - **99354** - Prolonged service in the office or other outpatient setting, requiring direct patient contact beyond the usual service (if applicable) #### 4) Reimbursement Ranges Reimbursement rates can vary significantly based on geographic location, payer contracts, and specific circumstances. However, general ranges for the listed CPT codes are as follows: - **72148**: $300 - $600 - **72149**: $400 - $800 - **72150**: $500 - $900 - **72040**: $100 - $200 - **72050**: $100 - $200 - **72070**: $100 - $200 - **97110**: $30 - $60 per 15 minutes - **97112**: $30 - $60 per 15 minutes - **20610**: $150 - $300 - **63030**: $1,500 - $3,000 - **99213**: $75 - $150 - **99214**: $100 - $200 - **99215**: $150 - $250 - **99354**: $50 - $100 #### 5) Billing Notes - Ensure that documentation supports the medical necessity of the services provided, particularly for imaging and surgical procedures. - Use modifiers as appropriate (e.g., modifier -50 for bilateral procedures). - Verify insurance coverage for specific procedures, as some may require prior authorization. - Be aware of local coverage determinations (LCDs) that may affect reimbursement for certain procedures. - Regularly update coding practices to align with changes in CPT and ICD-10 guidelines. ### Conclusion When coding for ICD-10 M53.80, it is essential to select appropriate CPT codes that reflect the diagnostic and treatment services provided. Accurate coding ensures proper reimbursement and compliance with healthcare regulations. Always refer to the latest coding manuals and payer guidelines for the most current information.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Impact of ICD-10 on M53.80 (Other Specified Dorsopathies, Site Unspecified)
1. Clinical Specificity vs. ICD-9
The transition from ICD-9 to ICD-10 has significantly enhanced clinical specificity. In ICD-9, dorsopathies were classified under broader categories with limited detail, often leading to vague diagnoses that did not accurately reflect the patient's condition. For instance, ICD-9 codes for dorsopathies lacked the granularity to specify the nature or location of the disorder.

ICD-9 vs ICD-10

Impact of ICD-10 on M53.80 (Other Specified Dorsopathies, Site Unspecified) 1. Clinical Specificity vs. ICD-9 The transition from ICD-9 to ICD-10 has significantly enhanced clinical specificity. In ICD-9, dorsopathies were classified under broader categories with limited detail, often leading to vague diagnoses that did not accurately reflect the patient's condition. For instance, ICD-9 codes for dorsopathies lacked the granularity to specify the nature or location of the disorder. In contrast, ICD-10 provides a more detailed classification system, allowing for the identification of specific types of dorsopathies, such as degenerative disc disease or other specified conditions, even when the site is unspecified. M53.80 captures a wider range of dorsopathy conditions, improving the ability to document and analyze patient data, which can lead to better-targeted treatments and improved patient outcomes. 2. Quality Measures The specificity of ICD-10 codes, including M53.80, plays a crucial role in quality measurement initiatives. Accurate coding allows healthcare...

Reimbursement & Billing Impact

Reimbursement Impact

Resources

Clinical References

Certainly! Below is a comprehensive list of resources related to ICD-10 code M53.80 (Other specified dorsopathies, site unspecified), categorized as requested. ### 1. Official Guidelines - **ICD-10-CM Official Guidelines for Coding and Reporting**: This document provides the official coding guidelines for the ICD-10-CM, including conventions, general coding guidelines, and specific coding instructions relevant to dorsopathies. Available at: [CMS ICD-10-CM Guidelines](https://www.cms.gov/medicare/coding/diagnosis-codes/2023-icd-10-cm-guidelines) ### 2. Clinical References - **Current Procedural Terminology (CPT) Professional Edition**: This reference includes coding for procedures related to dorsopathies and can help in understanding the clinical context of M53.80. - **Merck Manual of Diagnosis and Therapy**: Offers comprehensive information on dorsopathies, including symptoms, diagnosis, and treatment options. Available at: [Merck Manual](https://www.merckmanuals.com) ### 3. Professional Organizations - **American Academy of Orthopaedic Surgeons (AAOS)**: Provides resources and guidelines related to musculoskeletal disorders, including dorsopathies. Website: [AAOS](https://www.aaos.org) - **American Medical Association (AMA)**: Offers resources on coding and billing, including updates on ICD-10 codes. Website: [AMA](https://www.ama-assn.org) ### 4. Educational Materials - **AAPC (American Academy of Professional Coders)**: Offers online courses and webinars on ICD-10 coding, including specific modules on dorsopathies. Website: [AAPC](https://www.aapc.com) - **AHIMA (American Health Information Management Association)**: Provides educational resources and certification programs related to health information management and coding. Website: [AHIMA](https://www.ahima.org) ### 5. Online Tools - **CMS ICD-10 Lookup Tool**: An online tool that allows healthcare professionals to search for specific ICD-10 codes and their descriptions. Available at: [CMS ICD-10 Lookup](https://www.cms.gov/medicare/coding/diagnosis-codes/2023-icd-10-cm-lookup-tool) - **Optum360 ICD-10 Code Search**: A searchable database for ICD-10 codes that provides detailed descriptions and coding guidelines. Available at: [Optum360](https://www.optum360coding.com) These resources will assist healthcare professionals in understanding and accurately coding for M53.80, ensuring compliance with coding standards and improving patient care through precise documentation.

Coding & Billing References

Certainly! Below is a comprehensive list of resources related to ICD-10 code M53.80 (Other specified dorsopathies, site unspecified), categorized as requested. ### 1. Official Guidelines - **ICD-10-CM Official Guidelines for Coding and Reporting**: This document provides the official coding guidelines for the ICD-10-CM, including conventions, general coding guidelines, and specific coding instructions relevant to dorsopathies. Available at: [CMS ICD-10-CM Guidelines](https://www.cms.gov/medicare/coding/diagnosis-codes/2023-icd-10-cm-guidelines) ### 2. Clinical References - **Current Procedural Terminology (CPT) Professional Edition**: This reference includes coding for procedures related to dorsopathies and can help in understanding the clinical context of M53.80. - **Merck Manual of Diagnosis and Therapy**: Offers comprehensive information on dorsopathies, including symptoms, diagnosis, and treatment options. Available at: [Merck Manual](https://www.merckmanuals.com) ### 3. Professional Organizations - **American Academy of Orthopaedic Surgeons (AAOS)**: Provides resources and guidelines related to musculoskeletal disorders, including dorsopathies. Website: [AAOS](https://www.aaos.org) - **American Medical Association (AMA)**: Offers resources on coding and billing, including updates on ICD-10 codes. Website: [AMA](https://www.ama-assn.org) ### 4. Educational Materials - **AAPC (American Academy of Professional Coders)**: Offers online courses and webinars on ICD-10 coding, including specific modules on dorsopathies. Website: [AAPC](https://www.aapc.com) - **AHIMA (American Health Information Management Association)**: Provides educational resources and certification programs related to health information management and coding. Website: [AHIMA](https://www.ahima.org) ### 5. Online Tools - **CMS ICD-10 Lookup Tool**: An online tool that allows healthcare professionals to search for specific ICD-10 codes and their descriptions. Available at: [CMS ICD-10 Lookup](https://www.cms.gov/medicare/coding/diagnosis-codes/2023-icd-10-cm-lookup-tool) - **Optum360 ICD-10 Code Search**: A searchable database for ICD-10 codes that provides detailed descriptions and coding guidelines. Available at: [Optum360](https://www.optum360coding.com) These resources will assist healthcare professionals in understanding and accurately coding for M53.80, ensuring compliance with coding standards and improving patient care through precise documentation.

Frequently Asked Questions