ICD Code M54.5

ICD code M54.5 is used to classify and document the diagnosis of low back pain. This code is part of the International Classification of Diseases, 10th Revision (ICD-10), which is a standardized system used by healthcare providers to ensure consistency in diagnosing and billing for medical conditions. Low back pain, as indicated by this code, refers to discomfort or pain located in the lumbar region of the spine, which can be caused by a variety of factors such as muscle strain, herniated discs, or degenerative changes. Proper use of this code is essential for accurate medical record-keeping and for facilitating appropriate reimbursement from insurance providers.

When to use the ICD code for low back pain, consider the following diagnostic criteria and symptoms:

1. Location of Pain
- Pain localized to the lower back region.

2. Duration of Symptoms
- Symptoms persisting for more than a few days, typically classified as acute or chronic based on duration.

3. Severity of Pain
- Pain intensity ranging from mild to severe, affecting daily activities.

4. Radiating Pain
- Presence of pain that radiates to the legs or buttocks, indicating possible nerve involvement.

5. Functional Limitations
- Difficulty in performing routine activities such as bending, lifting, or standing for extended periods.

6. Associated Symptoms
- Presence of additional symptoms such as numbness, tingling, or weakness in the lower extremities.

7. History of Trauma
- Recent history of injury or trauma to the back, including falls or heavy lifting.

8. Previous Episodes
- History of recurrent low back pain episodes, indicating a pattern of chronicity.

9. Response to Treatment
- Evaluation of response to conservative treatments such as physical therapy, medication, or rest.

10. Exclusion of Red Flags
- Assessment to rule out serious underlying conditions (e.g., fractures, infections, malignancies) that may present with low back pain.

Utilizing these criteria can help healthcare providers determine the appropriate ICD code for accurate documentation and billing purposes.

For the ICD code M54.5, which pertains to low back pain, the relevant CPT codes that may be used for treatment include:

1. 99201-99205 - Evaluation and Management (E/M) services for new patients.

2. 99211-99215 - E/M services for established patients.

3. 97110 - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility.

4. 97140 - Manual therapy techniques, such as mobilization/manipulation, manual lymphatic drainage, and manual traction.

5. 97010 - Application of a modality to one or more areas; hot or cold packs.

6. 97035 - Ultrasound therapy.

7. 97112 - Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception.

8. 20552 - Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

9. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa.

10. G0283 - Electrical stimulation (unattended), to one or more areas for indications other than wound care.

These CPT codes are commonly associated with the treatment and management of low back pain, but the specific codes used will depend on the individual patient's treatment plan and the healthcare provider's clinical judgment. Always ensure that the selected CPT codes accurately reflect the services provided and are supported by the patient's medical record documentation.

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