Using the official codes from the 10th volume of the International Classification of Diseases, or ICD-10, helps update doctors in every medical field on the current data of common and rare medical conditions, the updated treatments of these ailments, and the source of disruptive symptoms like bodily pain in the upper back, thoracic spine, or the lumbar spine. The most recent update for the ICD-10 was effective on April 1, 2022 for COVID-19-related changes.
So what are the ICD-10 Codes for upper back pain and similar symptoms? All the codes for the conditions and approximate symptoms related to upper back pain can be found under section M54: Dorsalgia—the medical term for moderate or severe levels of pain in the upper back or the thoracic spine.
The ICD-10 Codes for upper back or thoracic pain are listed in Chapter 13, entitled “Diseases of the musculoskeletal system and connective tissue”. All conditions and symptoms related to this topic are denoted with the letter “M”. Upper back pain as a singular symptom is classified under “Other dorsopathies” as M54: Dorsalgia. The other codes under “Other dorsopathies” are related to disorders like cervical disc disorders and thoracic spine disorders.
The main code for dorsalgia or upper back pain is M54 ranging from M54.0 to M54.9. Another number will be added to denote the location of the pain or which nerve is causing it. For example, pain in the neck, or cervicalgia is labeled in the ICD-10 as M54.2. Another example is M54.1, the code for radiculopathy: better known as a pinched nerve in the cervical region or thoracic region.
The “Other dorsopathies” section notes that all of its codes exclude any diagnosis caused by an injury in the spine or discitis NOS (Not Otherwise Specified), a general infection of intervertebral discs. This is because these conditions are classified under different codes as there is an underlying medical diagnosis due to physical trauma or infection that is causing pain in the thoracic spine.
It is for this reason that each code may be listed with excluded causes to differentiate from other similar conditions listed in the ICD-10. For instance, radiculopathy, or M54.1, does not include pain due to neuralgia and neuritis NOS—pain in different areas in the face—and radiculopathy with intervertebral disc disorder, spondylosis, or disorders in the lumbar region and intervertebral discs.
There are two versions of the ICD-10: the ICD-10-CM, or ICD-10 Clinical Modification, for the codification of all the recorded medical diagnoses, and the ICD-10-PCS, ICD-10 Procedure Coding System, which lists all the codes for inpatient treatments in the U.S. The latter was implemented by the Centers for Medicare and Medicaid Services.
Hospitalization or surgeries may be done to provide instant and sustainable relief in cases of sudden, acute back pain or intensive chronic pain in the thoracic region or lumbar region. They are listed as seven alphanumeric codes and are used by healthcare experts and health insurance. However, private clinics will not commonly utilize these codes and only use the ICD-10-CM for documentation and insurance purposes.
New diagnosis codes are added to the ICD by The Centers for Disease Control and Prevention under the approval of the World Health Organization every year to constantly keep up with recent health statistics and trends in the U.S. These updates are found in the American version of the ICD-10 and may differ from other International editions.
On October 1, 2021, the ICD-10 codes for low back pain or lumbar pain were added and expanded upon, along with various classifications to diagnose a cough and officializing homelessness, housing instability, and other deficiencies of basic needs as a social deterrent to public health.
Low back pain is coded as M54.5 under the “Dorsalgia” section. M54.5 cannot be used for reimbursement purposes because it does not specify the exact or approximate cause of the lumbar back pain.
The new effective codes for lumbar pain, as of October 1, 2021, are M54.50, M54.51, and M54.59 classified as low back pain, unspecified; vertebrogenic low back pain; and other low back pain, respectively. These extended categories will inform doctors' principal diagnosis of low back pain and may be updated if continuous research is made or alternative causes of it are discovered.
ICD-10 codes are integral for the processes of hospitals and private clinics as the classified symptom or condition may require different treatments or classifications to apply for reimbursement as coded by the law and to better track data for health statistics across the U.S.
The proper identification of the implicit cause of upper back pain will lead to effective pain management, efficient data storage, and communication between hospitals, private clinics, and public health institutions. It will also help incorporate your personal history of medical conditions into the greater population so that trends in public health can be surveyed and analyzed for the yearly updates of the ICD.
Ensure that any code listed by your healthcare provider or documented in the principal diagnosis is the correct code for the condition or symptom because each code precisely denotes the source of pain and where it is located in the thoracic region or any part of the body.
Pain management requires a proper diagnosis of the region where the discomfort is experienced and where the source may lie. Without any form of treatment or intervention, the hourly episodes of pain may lead to chronic pain.
At Gramercy Pain Center, we offer an array of effective pain management treatments such as safe and quick-release medication, physical therapy, and minimally invasive surgeries to prevent any form of discomfort in all regions of the back from affecting your daily life. Schedule a consultation online to start immediately relieving your upper back pain.