Pain does not always reflect the extent of damage. The severity of pain from low back problems is often unrelated to the extent of physical damage present. For example, a simple pulled muscle in the low back can cause excruciating pain that can limit the ability to walk or even stand, whereas a large herniated disc can be completely painless. According to Merck, “[l]ow back pain (ICD-9 – 724.2) is multifactorial and may be related to acute ligamentous (sprain) or muscular (strain) problems, which tend to be self-limited, or to more chronic fibromuscular, osteoarthritic, or ankylosing spondylitic processes of the lumbosacral area. The prevalence of low back pain tends to increase with age, reaching 50% in persons >60 years of age.”1 “Back pain may be influenced by chronic, poor-quality or deficient sleep, fatigue, physical deconditioning, or psychosocial problems.”2  

In the lower back there are many anatomical structures that can cause severe low back pain and/or pain that radiates into the legs and/or feet. The interwoven structures include soft tissues (muscles, ligaments and tendons), bones (the structural building blocks of the spinal column), facet joints (which allow the spine to move), discs, and nerves, (which branch out from the spinal cord in the low back and innervate the legs and feet (supply an organ or body part with nerves or stimulate a nerve, muscle or body part to action).3

“Depending on the underlying cause of the back pain, treatment may include drugs, brief bed rest, massage, physical therapy, chiropractic, stretching exercises, surgery, and/or radiation.  Most non-malignant causes of back pain improve with a few days of rest, followed by 2 to 4 weeks of anti-inflammatory treatment, appropriate muscle strengthening, and patience.”4

“Almost everyone with a single acute attack of low back pain recovers over several days to 1 week, but attacks may recur or symptoms may become chronic in predisposed persons, especially if engaged in activities beyond their physical or psychologic capacities.”5

There is a one to one crosswalk (ICD-9 to ICD-10) for low back pain, NOS – see table below, but both ICD-9 and ICD-10 contain other types of back pain including, but not limited to, what is shown on the table below.

 ICD-9-to-ICD-10-Documentation-for-Lumbago-or-Low-Back-Pain

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.  This will also allow the coding staff to select the most appropriate ICD-9 or ICD-10 diagnosis code for reporting on the claim for reimbursement.

References:               

  • ICD-10-CM, 2014 Complete Draft Code Set, Chapter 13, Page 684, Diseases of the Musculoskeletal System and Connective Tissues (M00 – M99), AAPC, Optuminsight 2013
  • ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Chapter 13, Page 245, Diseases of the Musculoskeletal System and Connective Tissues, Editor – Anita C. Hart, Optuminsight August 2013

1The Merck Manual Seventh Edition, Centennial Edition, Section 5, Page 475, Editor – Keryn A. G. Lane, Publisher – Gary Zelko, June 1999.
2The Merck Manual Seventh Edition, Centennial Edition, Section 5, Page 475-476, Editor – Keryn A. G. Lane, Publisher – Gary Zelko, June 1999.
3Spine-health.com
4Taber’s Cyclopedic Medical Dictionary, pages 1488 - 1489, Editor – Donald Venes, M.D., M.S.J., Publisher.
5The Merck Manual Seventh Edition, Centennial Edition, Section 5, Page 477, Editor – Keryn A. G. Lane, Publisher – Gary Zelko, June 1999.

Author - Male

About the author

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