Is ICD-10-CM code M54 billable?

No, M54 (Dorsalgia) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code M54 belong to?

M54 belongs to Chapter 13 of the ICD-10-CM tabular list: M00–M99 (Diseases of the Musculoskeletal System and Connective Tissue).

M54Not billable, use a more specific code below

Dorsalgia

In Other dorsopathies (M50-M54), chapter 13: Diseases of the Musculoskeletal System and Connective Tissue

33 billable codes under M54: none are a CC or MCC; none map to an HCC.

Instructional notes

Excludes1: not coded here, use a different code

psychogenic dorsalgia (F45.41)

Also applies, from Other dorsopathies (M50-M54)

These notes sit on M50-M54 and apply to every code under it, including M54.

Excludes1: not coded here, use a different code

current injury - see injury of spine by body region
discitis NOS (M46.4-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers site and laterality, acute injury versus chronic musculoskeletal conditions, 7th characters for pathologic fractures, osteoporosis with or without current fracture, and multisystem inflammatory syndrome.

Site and laterality (page 60)
Acute traumatic versus chronic or recurrent musculoskeletal conditions (page 61)
Coding of Pathologic Fractures (page 61)
Osteoporosis (page 61)
Multisystem Inflammatory Syndrome (page 62)

Read Section I.C.13 (page 60)

All codes under M54

M54 can't be used on a claim. Pick a billable code below; grey headings group them.

M54 MS-DRGs

As the principal diagnosis, the billable codes under M54 group to MS-DRG 551, 552, 073, 074, 606, or 607 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 551 Medical Back Problems with MCC (25 of 33 codes)
DRG 552 Medical Back Problems without MCC (25 of 33 codes)
DRG 073 Cranial and Peripheral Nerve Disorders with MCC (5 of 33 codes)
DRG 074 Cranial and Peripheral Nerve Disorders without MCC (5 of 33 codes)
DRG 606 Minor Skin Disorders with MCC (3 of 33 codes)
DRG 607 Minor Skin Disorders without MCC (3 of 33 codes)

Other codes that refer to M54

Notes on these codes point to M54.

G55 Excludes1: nerve root compression (due to) (in) dorsopathies (M53.-, M54.-)
G89 Excludes2: spine pain (M54.-)
M20-M25 Excludes2: joints of the spine (M40-M54)
R10 Excludes2: dorsalgia (M54.-)
R52 Excludes1: spine pain (M54.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Back Pain

If you've ever groaned, "Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.