Low back pain is one of the most common health problems worldwide. It can result from muscle strain, poor posture, degenerative disc disease, or injury. Medical providers use ICD-10 codes to accurately document and report this condition for diagnosis, treatment, and billing.
When a patient presents with lower back pain that is not specified as due to another condition, the correct code to use is M54.5. This code identifies low back pain as the primary diagnosis and ensures consistent communication between healthcare providers, coders, and insurers.
Primary ICD-10 Code for Low Back Pain
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M54.5 — Low back pain
This code applies when the pain is located in the lumbar region and the cause is not otherwise specified. If the provider identifies a more specific cause such as sciatica, lumbago with sciatica, or radiculopathy, then a more specific code should be used instead.
Common ICD-10 Codes Related to Back Pain
| ICD-10 Code | Description |
|---|---|
| M54.5 | Low back pain |
| M54.40 | Lumbago with sciatica, unspecified side |
| M54.41 | Lumbago with sciatica, right side |
| M54.42 | Lumbago with sciatica, left side |
| M54.50 | Low back pain, unspecified |
| M54.59 | Other low back pain |
Note: Always review the patient’s medical record to ensure coding accuracy. Specificity improves clinical data quality and reduces claim denials.
Why ICD-10 Coding for Low Back Pain Matters
Accurate ICD-10 coding for low back pain supports:
- Correct medical billing and insurance reimbursement
- Consistent tracking of patient outcomes
- Effective treatment planning and research
- Proper classification of musculoskeletal disorders
Inaccurate or non-specific coding may lead to reimbursement issues or incomplete patient records.
Example Clinical Documentation
Example:
A 45-year-old patient reports mild pain in the lower back without radiation, numbness, or tingling.
Appropriate ICD-10 Code: M54.5 — Low back pain
If the same patient experienced back pain radiating down the right leg, the appropriate code would be M54.41 — Lumbago with sciatica, right side.
Key Takeaways
- The ICD-10 code for low back pain is M54.5
- Use M54.50 or M54.59 when additional details are specified
- Always code based on the exact location and symptoms
- Proper coding improves accuracy, billing efficiency, and patient care
The ICD-10 code for low back pain is M54.5. This code is used to document pain in the lower back when no specific underlying cause is identified. Accurate coding helps ensure proper diagnosis, billing, and treatment tracking.