Lower back pain, which is commonly referred to as lumbago, is no longer a concern limited to older adults. With long hours spent sitting at desks, even younger people are now experiencing the same issues. Healthcare professionals continually strive to identify the causes of this pain to deliver the most effective treatments.
Correctly identifying and managing lower back pain has always been a challenge for clinicians. Recent updates to the ICD-10 classification of low back pain, including codes such as M54.50, represent a significant shift in the classification of back pain.
In this article, we’ll break down what these changes mean, how ICD-10 codes classify lower back pain, and why this new clarity helps both healthcare providers and patients better diagnose and manage the condition.
What is ICD-10 Code M54.50?
This is the low back pain ICD 10 code for “Low back pain that is unspecified.”
- It’s used when a patient presents with lower back pain, but the documentation doesn’t specify whether it’s acute, chronic, radicular, mechanical, etc.
- The code was introduced in the 2022 ICD-10-CM update to give coders a distinct option for unspecified low back pain.
- It falls under Chapter 13 (“Diseases of the musculoskeletal system and connective tissue”) in the ICD-10-CM.
- If the provider documents more detail (for example, low back pain with sciatica, mechanical low back pain, or chronic low back pain), a more specific code from the M54 category (such as M54.40, M54.41, or M54.59) may be required instead.
Commonly Used Synonyms for Low Back Pain – M54.50 ICD-10
Accurate terminology helps clinicians, coders, and billing teams document and communicate lower back pain effectively. While ICD-10 M54.50 is used for unspecified low back pain, a variety of related terms describe different patterns and causes of this condition. The table below outlines the most common types and synonyms of lower back pain, along with a brief description of each.
Pain Type |
Description |
| Acute low back pain | Sudden onset, often caused by a strain or injury. |
| Chronic low back pain | Pain lasting for more than 3 months. |
| Intractable low back pain | Severe pain that doesn’t respond well to treatment. |
| Loin pain | Pain in the lower back on either side of the spine. |
| Low back pain in pregnancy | A common occurrence due to hormonal changes and weight gain. |
| Mechanical low back pain | Pain originating from muscles, ligaments, or discs. |
| Myofascial pain syndrome | Pain and tenderness in trigger points within muscles. |
| Sacral back pain | Pain in the lower spine near the buttocks. |
| Tenderness of the lumbar spine | Localized pain or discomfort in the lower back. |
| Sub-acute low back pain | Pain lasts between about 6 and 12 weeks. |
| Recurrent low back pain | Pain that comes and goes periodically. |
| Radicular pain (sciatica) | Pain that radiates from the lower back into the leg(s), typically due to nerve root irritation. |
| Axial (non-radicular) low back pain | Pain that is more localized and doesn’t radiate; often mechanical in nature. |
| Inflammatory low back pain | Pain due to inflammation (e.g., ankylosing spondylitis). |
| Specific low back pain | Pain with an identifiable cause or pathology (fracture, infection, tumor, etc.). |
| Non-specific low back pain | Pain without a clearly identifiable structural cause. |
ICD-10 M54.5: Where Did It Go and What Replaced It?
With the most recent ICD-10 update, the M54.5 diagnosis code was rendered non-billable as of 2023. Previously, this code encompassed a wide spectrum of unspecified lower back pain, regardless of its type or intensity. It was typically used when the exact cause of low back pain was unknown, but still had a noticeable impact on a patient’s everyday life.
Lower back pain affects people across all age groups, and its underlying causes can differ significantly from one individual to another. The Centers for Medicare & Medicaid Services (CMS) noted that accurate classification is essential to truly capture what a patient is experiencing.
For this reason, CMS decided to retire M54.5 and split it into more precise categories, ensuring clearer interpretation for both healthcare providers and insurance carriers.
As a result, today’s ICD-10 system offers more detailed, descriptive codes for lower back pain, making it easier to reflect the severity and nature of each case.
The Emergence of M54.50 and Other Specific ICD-10 Codes for Lower Back Pain
CMS now emphasizes the use of more specific diagnoses for lower back pain and has introduced precise ICD-10 codes to better classify these conditions. This greater level of detail is especially valuable in workers’ compensation cases, where accurate diagnoses are essential for proper processing and reimbursement.
The former M54.5 code has now been broken down into more detailed ICD-10 codes for low back pain, allowing healthcare providers to capture the nature and severity of the condition more accurately.
ICD-10 Code |
Condition |
Description |
| S39.012 | Low back strain | Common injuries from lifting or twisting |
| M51.2- | Lumbago due to intervertebral disc displacement | Pain caused by a slipped disc |
| M54.4- | Lumbago with sciatica | Pain radiating down the leg |
| M54.50 | Low back pain, unspecified | Used when the cause remains unclear but the pain is significant |
| M54.51 | Vertebrogenic low back pain | Pain originating from the spine (vertebrogenic) |
| M54.59 | Other low back pain | Used for less common causes of low back pain |
| S37.401A | Unspecified trauma to intervertebral disc (initial encounter) | Initial encounter with unspecified trauma to the intervertebral disc |
| S37.401D | Unspecified trauma to intervertebral disc (subsequent encounter) | Subsequent encounter with unspecified trauma to the intervertebral disc |
| S37.401S | Unspecified trauma to the intervertebral disc (complications) | Complications of unspecified trauma to the intervertebral disc |
| M51.36 | Other intervertebral disc degeneration, lumbar region | Degeneration of the intervertebral disc in the lumbar region |
| M51.37 | Other intervertebral disc degeneration, lumbosacral region | Degeneration of the intervertebral disc in the lumbosacral region |
| M53.2X | Spinal instabilities, lumbar region | Spinal instability conditions specific to the lumbar region |
| M53.86 | Other specified dorsopathies, lumbar region | Other specified disorders affecting the lumbar spine |
Why the New ICD-10 Updates and Specific Codes Matter
The new, more detailed ICD-10 codes provide a much clearer picture of lower back pain. This increased specificity benefits every aspect of healthcare delivery, from improving patient care and streamlining insurance interactions to ensuring smoother medical billing and workers’ compensation claims.
Healthcare providers who need additional support with medical billing services can partner with specialized billing companies in California to ensure accurate coding and timely reimbursements. By proactively adopting these updated codes, providers and billing partners can collaborate to simplify the complexities surrounding lower back pain, ultimately delivering better outcomes for patients.
Better Diagnosis, Better Compensation — Powered by Liberty Liens
Running a medical practice, especially in fields such as orthopedics, pain management, or physical medicine, means juggling far more than just patient care. When a patient’s injury is work-related, the paperwork, coding, billing, and follow-ups can feel endless. Every form, every call to an insurer, every missing detail slows down not only your reimbursements but also your staff’s energy for the people in front of them.
At Liberty Liens, we understand how overwhelming workers’ compensation billing and lien collections can become. We partner with doctors across California to alleviate the burden of these administrative tasks. Our team tracks deadlines, manages the back-and-forth with carriers, and keeps every claim compliant so your revenue isn’t left hanging.
For pain management specialists, orthopedic surgeons, and other healthcare providers treating lower back injuries, our mission is straightforward. It is designed to eliminate administrative burdens, allowing you to focus on your patients. The result is faster payments, fewer denials, and a clear, organized record of every claim from start to finish.
