Wiki M54.5 DX CODE INVALID?

[Kiki50]

I have received a ton of denials lately regarding M54.5 being invalid. I work for an Ortho Spine Sx and assign it for "low back pain" ..... Denials are from Cigna, BCBS mainly.
Am I missing something??

Thank you so much for the help!

 

[sls314]

I have received a ton of denials lately regarding M54.5 being invalid. I work for an Ortho Spine Sx and assign it for "low back pain" ..... Denials are from Cigna, BCBS mainly.
Am I missing something??

Thank you so much for the help!

Correct - M54.5 is invalid as of 10/1/2021. Are you using old books, perhaps?

It now needs a 5th digit. You'd have to use one of the following codes depending on which is applicable to each patient:

M54.50 - Low back pain, unspecified
M54.51 - Vertebrogenic low back pain
M54.59 - Other low back pain

 

[Kiki50]

Susan thank you! When I try to input M54.50 the system tells me that it's a Invalid code and to try again. We use EClinical.

I am super new to coding although I've been in the medical field for over 25 yrs., so this helps. I guess I need to contact support for EClinical. I really appreciate your quick response & help!

 

[amyjph]

Sounds like the practice management software needs updating.

 

[jkyles]

Susan thank you! When I try to input M54.50 the system tells me that it's a Invalid code and to try again. We use EClinical.

I am super new to coding although I've been in the medical field for over 25 yrs., so this helps. I guess I need to contact support for EClinical. I really appreciate your quick response & help!

Have you pulled the payer's policy for the procedure you're billing? I'm wondering if the system is set up to reject codes that the payer doesn't allow for a procedure.

 

[OpenClaims]

Firstly, I would ask the organization to perform an update to your coding software, as it seems the newest coding guidelines may be outdated. Secondly, M54.5 was updated with a specified place holder, including zero. So, M54.5 is now M54.50. Hope this helps!