ICD-10 Codes for Back Pain
The primary ICD-10 code for nonspecific low back pain is M54.5, while back pain without further specification is coded as M54.9.
Primary Coding Options
The ICD-10 system provides several codes for back pain depending on the clinical presentation:
- M54.5 is the specific code for "low back pain" and was the second most frequently used pain-related code (18% of cases) in clinical practice 1
- M54.9 codes for "dorsalgia, unspecified" (back pain without further specification)
- R52.2 codes for "other chronic pain" and was historically the most common code used (29% of cases), though this is a non-specific designation 1
Diagnostic Category-Based Coding
The coding approach should align with the three guideline-endorsed diagnostic categories 2, 3:
For Nonspecific Low Back Pain
- Use M54.5 (low back pain) when there are no signs of serious underlying condition, spinal stenosis, radiculopathy, or another specific spinal cause 4, 3
For Radiculopathy or Spinal Stenosis
- M54.1 codes for radiculopathy
- M48.06 codes for spinal stenosis of lumbar region
- M51.1 codes for lumbar disc disorders with radiculopathy 2
For Specific Spinal Pathology
- M80-M85 range for vertebral compression fractures related to osteoporosis 2
- M45 codes for ankylosing spondylitis 2
- C79.5 codes for secondary malignant neoplasm of bone and bone marrow (when cancer is suspected) 2
- M46.2-M46.5 codes for vertebral osteomyelitis and discitis (spinal infection) 2
Critical Coding Considerations
The ICD-10 system has significant limitations for back pain coding - it provides poor specificity for the underlying cause and often forces clinicians to use vague codes like "other chronic pain" (R52.2) for nearly one-third of patients 1. The system contains substantial redundancy with up to 22 codes for the same clinical condition and does not align well with contemporary diagnostic approaches 5.
When coding, avoid defaulting to R52.2 ("other chronic pain") when a more specific anatomical code like M54.5 is appropriate, as this provides better clinical information for treatment planning and resource allocation 1.
Regional Pain Codes
- M79.6 codes for "pain in limb" (13% usage frequency) 1
- M54.2 codes for cervicalgia (neck pain)
- M54.6 codes for pain in thoracic spine 6
The M54 series (dorsalgia) represents the most clinically useful category for documenting back pain location while the R52 series should be reserved for cases where pain cannot be better specified 1, 5.