ICD cod M54.59 is used to classify “other low back pain.” The code is part of the ICD 10 – International Class of Diseases, 10th Revision, a standardized system used by healthcare practitioners to diagnose and classify medical conditions. Visit – (25) Determine ICD-10 Code For Low Back Pain | LinkedIn – for codes for low back pain.
The classification as “other low back pain,” such as those caused by certain injuries or diseases is a broad class that allows providers to communicate the presence of low back pain that does not align with more specific classifications.
This assures more accurate documentation, facilitating an appropriate care plan, and streamlining billing for services related to low back pain.
ICD 10 Coding for Low Back Pain – New Guidelines
Rehabilitation clinics see low back pain as a leading condition. Still, they need a proper diagnosis to achieve the best care plan and results as well as efficient billing and thorough documentation. Millions of people are affected by chronic and acute low back pain.
Therapists are increasing encountering this diagnosis, making it vital to remain current on the ICD 10 coding. The diagnosis is identified by three primary types according to the NIAMS – National Institute of Arthritis and Musculoskeletal and Skin Diseases.
- Chronic: Chronic pain persists for over three months, resulting from varied causes, including structural or mechanical problems, inflammatory concerns or other underlying diseases.
- Subacute: Subacute pain lasts up to 12 wees and is typically resolved without major intervention.
- Acute: Acute pain can last as long as 4 weeks and results from strain or injury.
Selecting the correct ICD 10 code depends on understanding the patient’s pain cause and its duration. Some causes can include the following.
- Inflammatory: Ankylosing spondylitis is a type of arthritis that leads to long-term inflammation and can result in low back pain.
- Structure/mechanical issues: Sprains/strains, misalignment or rupture or degenerated spinal discs are typical causes of chronic low back pain.
- Other: Infections, osteoporosis, changes related to pregnancy can all result in low back pain Identifying the variables helps ensure the most specific ICD 10 code is used.
Recently, coding for low back pain has changed. Previously, rehab therapists used ICD 10 code M54.5 frequently for general low back pain.
As part of an update by CMS – Centers for Medicare and Medicaid Services in 2022, this code was replaced by a set of specific codes to capture a nuance of low back pain conditions. Go here for to learn more about ICD 10 code M54.59 in 2025.
The three primary ICD 10 codes currently used for this diagnosis include:
M54.50 – Low bac pain, unspecified
M54.51 – Vertebrogenic low back pain
M54.59 – Other low back pain
M54.50: Low Back Pain, Unspecified
M54.50 ICD 10 code is used for low back pain cases where the precise cause is unspecified. When a patient presents with generalized low back pain and the practitioner cannot identify a more specific cause when diagnosing, this code fits that situation.
When using this code, it’s essential to make sure that there isn’t a more specific diagnosis code to apply. If vertebrogenic or sciatic pain can be identified, one of these codes should be used.
Excludes1 Edits for M54.50
Note that M54.50 has specific Excludes1 edits, meaning certain conditions should not be coded together with this ICD 10 code, such as:
M54.4- Lumbago with Sciatica
M51.2- Lumbago due to intervertebral disc displacement
S39.012 Low back strain
M54.51: Vertebrogenic Low Back Pain
This code is used for a type of pain caused by damage to the vertebral endplates or the structures between the vertebrae and discs that help maintain the spine’s stability. It can be influenced by many variables including:
- General body wear and tear
- Family history of low back pain
- Being tall
- Obesity
- Physically demanding job
- Smoking
Excludes1 Edits for M54.51
The following Excludes1 edits exist for this ICD 10 code:
S39.012 Low back strain
M54.4- Lumbago with sciatica
M51.2- Lumbago due to intervertebral disc displacement
M54.59: Other Low Back Pain
This ICD 10 code is used when the patient’s low back pain doesn’t fit into any specific classification. It’s a sort of “catch-all” for codes that don’t fit into the other two groups.
It’s vital to be as specific as possible when coding for quality patient care and billing purposes, there can be cases where M54.59 is the most appropriate choice. If symptoms don’t align with a specific diagnosis, it could capture the general nature of the pain.
Exludes1 Edits for M54.59
S39.012 Low back strain
M54.4 Lumbago with sciatica
M51.2 Lumbago due to intervertebral disc displacement
Final Thought
Low back pain ICD 10 coding can be complex, but the process can be simplified when rehab therapists understand each code’s nuances.
The priority is to be as specific as possible when coding whether the low back pain is generalized, other, or vertebrogenic, to streamline the billing process, reduce the potential for denials, and improve the patient experience.