ICD Code M54.6

ICD code M54.6 is used to identify and classify the diagnosis of pain located in the thoracic spine, which is the middle section of the vertebral column. This code helps healthcare providers document and communicate the specific type of spinal pain a patient is experiencing, facilitating accurate billing and efficient management of healthcare services.

1. Localized Pain: The patient reports pain specifically in the thoracic region of the spine, which is the area between the neck and the lower back.

2. Pain Duration: The pain has persisted for a significant period, typically more than a few days, and is not attributed to acute injury or trauma.

3. Pain Characteristics: The pain may be described as sharp, dull, aching, or burning, and it may vary in intensity.

4. Exclusion of Other Conditions: Other potential causes of thoracic pain, such as fractures, infections, or malignancies, have been ruled out through diagnostic imaging or other relevant tests.

5. Impact on Daily Activities: The pain affects the patient's ability to perform daily activities, such as bending, lifting, or twisting, and may also impact posture.

6. Associated Symptoms: There may be associated symptoms such as muscle stiffness, tenderness upon palpation, or limited range of motion in the thoracic spine.

7. Response to Treatment: The pain may have shown some response to conservative treatments such as physical therapy, pain medication, or rest, but persists nonetheless.

8. Patient History: The patient's medical history does not indicate any chronic conditions that could explain the thoracic pain, such as arthritis or osteoporosis, unless these have been specifically ruled out as the primary cause.

9. Physical Examination Findings: A physical examination reveals tenderness or discomfort upon palpation of the thoracic spine, without signs of neurological deficits.

10. Referral for Further Evaluation: If initial treatments do not alleviate the pain, the patient may be referred for further evaluation by a specialist, such as an orthopedic or pain management specialist, to confirm the diagnosis and explore additional treatment options.

For the ICD code M54.6, which pertains to pain in the thoracic spine, 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, again depending on complexity and time.

3. 20552 - Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

4. 20553 - Injection(s); single or multiple trigger point(s), 3 or more muscles.

5. 97110 - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility.

6. 97112 - Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception.

7. 97140 - Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

8. 97010 - Application of a modality to 1 or more areas; hot or cold packs.

9. 97035 - Application of a modality to 1 or more areas; ultrasound, each 15 minutes.

These CPT codes are examples of procedures and services that might be used to address the condition associated with ICD code M54.6. It's important for healthcare providers to select the appropriate CPT codes based on the specific services rendered and the patient's individual treatment plan.

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