ICD Code 54.5 (Low Back Pain) Unavailable Starting October 1

An important code that is used frequently by physical therapists will no longer be available after September. New and revised ICD-10 updates are effective 10/1/2021.

Effective 10/1/2021: M54.5 – Low Back Pain will no longer be allowed. Instead, ICD-10 will require the use of more specific codes, such as the following:

·        S39.012: Low back strain

·        M51.2: Lumbago due to intervertebral disc displacement

·        M54.5: Lumbago with sciatica

·        M54.50: Low back pain, unspecified

·        M54.51: Vertebrogenic low back pain

·        M54.59: Other low back pain

CMS has posted details about the change here.

What does this mean?

·        If patients currently have a diagnosis of M54.5, then it will need to be updated on October 1 (please don’t update prior to that since you may be using a new diagnosis that is not effective until October 1). You may wish to document the reason for updating the diagnosis on the date you make that change.

·        Most EMRs will be prompting for these changes on October 1, and some may already be giving you messages that changes are coming.