Major Change For Low Back Pain Billing
Effective October 1, 2021 the code for Low Back Pain, M54.5, will be deleted from the current ICD10 coding list. The low back pain code is one of the most used codes by providers. To add to code specification, it is being replaced with 3 new coding options:
M54.50 Low Back Pain, unspecified, includes low back pain and lumbago
M54.51 Vertebrogenic low back pain
M54.59 Other Low Back Pain
Please DO NOT use M54.5 effective 10-1-2021 as claims will not be processed
Although we are hoping for a smooth transition with this change, chances are that it will be a rocky start. I would advise not to bill the new back pain codes as primary diagnosis if possible for the first couple of months to avoid potential denials.
Insurance carriers must update all of their policy bulletins to reflect this change in order for carriers to actually pay on these codes. Currently, none are scheduled to do so in October which can interfere with claims processing correctly if billed.
As always, please don’t hesitate to reach out with any questions or concerns!
305-204-1090