Most of the time, when we visit our doctor for a medical problem, we spend a few minutes with the PA or NP, a few minutes with the doctor, pay our co-pay, and head home. Very few of us actually see the bill or the coding that is used by the doctor and sent to the insurance company. So very few of us ever know what an ICD code is or what its purpose is.
What Are ICD Codes?
The term “ICD” stands for ‘International Classification of Diseases’. These are codes that are assigned to various diseases and conditions that affect people in their daily lives. This system is used by physicians and healthcare providers to classify and code all diagnoses, symptoms and procedures that are done when providing healthcare services to patients.
Why Are ICD Codes Important?
ICD codes are important because they give the healthcare community a common language to use for the recording, reporting, and monitoring of diseases. When we have a common language that can be used around the world, different countries can compare and share data about diseases in a uniform and consistent way. This helps healthcare professionals to track trends and analyze various conditions in order to treat patients better. ICD codes also enable the sharing of data between hospitals and regions.
The History of ICD Codes
The ICD system was created to track morbidity (health issues) and diseases within populations. Over the years, along with CPT (current procedural terminology) codes, ICD has evolved into the “most widely used statistical classification system in the world”. It is also the system on which reimbursement for insurance claims is based in the US.
As healthcare evolves and advances, so must the classification system. The ICD system has gone through many revisions, the latest of which is called ICD-11. ICD 10 began development in 1983 and was only eventually mandated by the USA in 2015. ICD-10 is still in place, but ICD 11 was released in January 2022 and will become the new gold standard.
What Are The Differences Between ICD-10 and ICD-11?
Some of the main differences between ICD-10 and ICD-11 are the following:
1. More Detail
ICD-11 has a more sophisticated and categorized structure than ICD-10. This means that codes will be even more specific and can be used in a broader range of classifications for diseases, disorders, injuries, and causes of death. For example, instead of saying someone died in a motor vehicle accident, the coding could reflect that specific injuries were generated via specific aspects of the accident.
2. More Global Application:
ICD-11 will have more international usage with guidance for different cultural experiences and influences. It will also provide translations into 43 different languages.
3. Digital Readiness:
ICD-11 is more intuitive when it comes to digital health records in the digital age. It will be easier to integrate with various electronic health applications.
4. Pandemic Ready:
ICD-11 will have emergency pandemic codes built into it to help confirm a Covid-19 diagnosis, classify conditions, and establish COVID-19 as the actual cause of death. It will also record information regarding COVID-19 vaccinations and adverse reactions to the vaccinations.
While ICD-11 took effect on January 1, 2022, it will probably take some time for it to become properly established throughout the healthcare industries around the globe.
How Do ICD Codes Affect Low Back Pain?
Low back pain is notoriously difficult to diagnose and to treat. The more information that we can gather around this condition, the better our chances are of being able to manage the condition in the future. If we are able to gather vast amounts of data on how their back pain first started, or what types of activities and things cause flare ups, the better informed we are on how to anticipate, treat, or even prevent low back pain from happening.
Having accurate information around low back pain can also help the healthcare industry in the following ways:
Track complications and the severity of the condition,
Track comorbidities that occur with low back pain
Measure current standards of care that are provided to patients
Help make better clinical/treatment decisions
Identify when a condition could be fraudulent and be used to claim disability unlawfully.
Help track the effects of low back pain on the workforce and employment
Help individuals receive reimbursement for new treatments and therapies that show effectiveness in managing the condition.
What Are The ICD-10 Codes for Low Back Pain?
Some of the main codes used in managing low back pain are the following:
› M00-M99 Diseases of the musculoskeletal system and connective tissue
› 2022 ICD-10-CM Diagnosis Code M54.5
2022 ICD-10-CM Diagnosis Code M54.5
Low back pain
M54.5 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
The current code, M54.5 (Low back pain), will be expanded into three more specific codes:
M54.50 (Low back pain, unspecified)
M54.51 (Vertebrogenic low back pain)
M54.59 (Other low back pain)
M54.10 – Radiculopathy, site unspecified
M54.30 – Sciatica, unspecified side
M54.31 – Sciatica, right side
M54.32 – Sciatica, left side
Type 1 Excludes
low back strain (S39.012)
lumbago due to intervertebral disc displacement (M51.2-)
lumbago with sciatica (M54.4-)
What Is The ICD-11 Code For Low Back Pain?
Back pain falls under the stem code of “spinal pain” in the ICD-11 system. It is named as back pain NOS (no other symptoms) and pain in the back as inclusion terms under the main category “ME84”. The Back Pain ICD-11 code is ME84.Z.
While the average person suffering from low back pain is probably not going to see the codes generated by their healthcare visit, gathering this information will ultimately benefit those suffering with the condition.
The more the community can learn about the causes of low back pain and how to diagnose the condition, the better we can see which treatments are the most effective and learn how to prevent the condition in the first place.
It has been said that prevention is better than cure, and those who suffer with their backs would surely agree with that statement. So, next time you experience low back pain, while it might feel like going to your doctor doesn't have much of an impact, you can feel good that you are contributing to the wealth of knowledge about the condition and that you are contributing to research and future results.