ICD Code M54.5

ICD code M54.5 is used to identify and classify the diagnosis of low back pain. This code is part of the International Classification of Diseases (ICD) system, which is utilized by healthcare providers to document and report various health conditions. Low back pain, as indicated by this code, refers to discomfort or pain located in the lower back region, which can be caused by a variety of factors such as muscle strain, herniated discs, or underlying medical conditions. Accurate use of this code is essential for proper billing, treatment planning, and statistical analysis in healthcare settings.

When considering the use of the ICD code for low back pain, it is essential to evaluate the patient against specific diagnostic criteria and symptoms. Here is an ordered list of criteria to guide healthcare providers:

1. Pain Localization: The patient reports pain primarily located in the lumbar region of the spine, which may or may not radiate to the buttocks or legs.

2. Pain Duration: The low back pain has persisted for a duration that can be acute (less than 6 weeks), subacute (6 to 12 weeks), or chronic (more than 12 weeks).

3. Pain Intensity: The patient describes the pain as mild, moderate, or severe, impacting daily activities and quality of life.

4. Pain Onset: The onset of pain may be sudden, often following physical activity, or gradual, developing over time without a specific triggering event.

5. Functional Impairment: The patient experiences difficulty in performing routine activities such as bending, lifting, sitting, or standing for extended periods.

6. Exclusion of Specific Pathologies: The pain is not attributable to specific underlying conditions such as fractures, infections, malignancies, or inflammatory diseases, which would require different ICD codes.

7. Absence of Neurological Deficits: There are no significant neurological symptoms such as numbness, tingling, or weakness in the lower extremities that would suggest nerve root involvement or other serious conditions.

8. Response to Initial Treatment: The patient may have shown partial or no improvement with initial conservative treatments such as rest, physical therapy, or over-the-counter pain medications.

9. Patient History: A thorough patient history does not reveal red flags such as recent trauma, unexplained weight loss, or a history of cancer, which would necessitate further investigation.

10. Physical Examination Findings: The physical examination may reveal tenderness in the lumbar region, limited range of motion, or muscle spasms, but no signs of systemic illness.

By carefully assessing these criteria, healthcare providers can accurately determine when to use the ICD code for low back pain, ensuring appropriate documentation and management of the condition.

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

1. 99201-99205 - Evaluation and Management (E/M) services for new patients, depending on the complexity and time spent.

2. 99211-99215 - E/M services for established patients, based on the level of service provided.

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

8. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa.

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

These CPT codes are commonly used in the treatment 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 align with the services provided and are supported by appropriate documentation.

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