Back pain (724.5) ranks seventh in the top ten diagnosis codes worked up in the emergency department (ED) and coded by McKesson. It is typical for an ED physician to document back pain, without specifying the location of the pain. The back is a huge area and there are several codes that describe pain in the back area from the neck down to the lumbar region or lower part of the back. ICD-9 has a one- to-one crosswalk to ICD-10 for back pain, or dorsalgia unspecified, 724.5 - M54.9.

Most people have experienced back pain sometime in their life. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms. Back pain may be influenced by chronic poor quality or deficient sleep, fatigue, physical deconditioning, or psychosocial problems and conflicts.

The frequency, duration, location, and severity of the back pain, the factors that make it better or worse, associated signs and symptoms - such as stiff neck, pain running down the legs, and mechanical circumstances help identify the cause of the back pain. This will help determine the type of back pain the patient is experiencing and the course of action for treatment.

There is a one-to-one crosswalk for back pain unspecified, but there are other types of back pain (depending on the location of the pain) as outlined in the below table.

ICD-9 to ICD-10 Documentation for Back Pain

Treatment for back pain depends on the patient’s history and the type of severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of the treatment plan. Other treatment plans for back pain include rest, heat and ice packs, massage and medications. Medications can be over the counter type, anti-inflammatory and other pain medications up to and including narcotics.

Back pain codes are located in several sections of ICD-9 depending on the type of back pain diagnosed.  Pain disorders related to psychological factors, section 307.8, includes the back pain related to psychological factors (307.89). 

As you can see in the above table there are a number of ICD-10 codes for back pain – and this is only a small example of those in both ICD-9 and ICD-10 books. It is imperative that the provider document exactly what the examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study.

ICD-10-CM, Complete Draft Code Set, Chapter 13
ICD-9-CM, Chapter 13
Merck Manual, Section 5, Pages 475-478 Musculoskeletal and Connective Tissue Disorders and Section 14, Pages 1373-1374 Neurologic Disorders

This commentary does not supplant the American Medical Association’s (AMA) current listing of Current Procedural Terminology (CPT®) codes, its documentation in the annual CPT Changes publications, and other related publications from the AMA, which are the authoritative source for information about CPT codes. Please refer to your 2015 CPT Code Book, annual CPT Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes, and interpretations that may not be reflected in this document.

CPT is a registered trademark of the AMA. The AMA is the owner of all copyright, trademark, and other rights to CPT and its updates. MLN Matters® is a registered trademark of the U.S. Department of Health and Human Services

Author - Male

About the author

Robert Bunting, CPC, CPC-H, CHC, CEDC, CEMC, CAC is Compliance Director – Emergency Medicine, McKesson Business Performance Services.