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 CodesM54.51

M54.51

Billable

Vertebrogenic low back pain

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

Code Description

ICD-10 M54.51 is a billable code used to indicate a diagnosis of vertebrogenic low back pain.

Key Diagnostic Point:

Vertebrogenic low back pain refers to pain originating from the vertebrae or spinal structures, often resulting from degenerative changes, trauma, or other pathological conditions affecting the spine. This type of low back pain can manifest as localized discomfort in the lumbar region, which may radiate to the lower extremities, mimicking symptoms of sciatica. Patients may describe the pain as sharp, dull, or throbbing, and it can be exacerbated by movement, prolonged sitting, or certain positions. The condition is often associated with other symptoms such as stiffness, reduced range of motion, and muscle spasms. Diagnosis typically involves a thorough clinical evaluation, including a detailed history and physical examination, and may be supported by imaging studies such as X-rays or MRI to identify underlying structural issues. Management strategies can be conservative, including physical therapy, medications, and lifestyle modifications, or surgical interventions in cases where conservative measures fail to provide relief or when there is significant neurological compromise.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating vertebrogenic pain from other types of back pain.
  • Need for precise documentation of symptoms and treatment responses.
  • Variability in treatment approaches (conservative vs. surgical).
  • Potential for co-existing conditions that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of the specific nature of the pain.
  • Failure to document conservative treatment attempts before surgery.
  • Misclassification of pain type leading to incorrect coding.
  • Lack of imaging results to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of the patient's back pain, including onset, duration, and previous treatments.

Common Clinical Scenarios

Patients presenting with chronic low back pain due to degenerative disc disease or vertebral fractures.

Billing Considerations

Documentation should include any imaging studies and the rationale for surgical intervention if applicable.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and treatment goals.

Common Clinical Scenarios

Patients undergoing rehabilitation for low back pain post-injury or surgery.

Billing Considerations

Focus on documenting progress and response to conservative management strategies.

Coding Guidelines

Inclusion Criteria

Use M54.51 When
  • According to ICD
  • 10 guidelines, M54
  • 51 should be used when the low back pain is specifically attributed to vertebral structures
  • Documentation must clearly indicate the vertebrogenic nature of the pain, and any associated conditions should be coded as well

Exclusion Criteria

Do NOT use M54.51 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used when injecting corticosteroids for pain relief in vertebrogenic low back pain.

Documentation Requirements

Document the indication for injection and response to previous conservative treatments.

Specialty Considerations

Orthopedic specialists often perform this procedure.

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 nuances of vertebrogenic pain and its management, which can lead to better treatment outcomes and reimbursement.

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 nuances of vertebrogenic pain and its management, which can lead to better treatment outcomes and reimbursement.

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

What is the difference between vertebrogenic low back pain and other types of low back pain?

Vertebrogenic low back pain specifically originates from the vertebrae or spinal structures, while other types may arise from muscular, neurological, or visceral sources. Accurate diagnosis is crucial for appropriate management.