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Wiki M54.5 DX CODE INVALID?

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Kiki50

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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!
 
Kiki50 said:
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!
Click to expand...


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
 
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!
 
Kiki50 said:
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!
Click to expand...
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.
 
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ask the organization to perform an update to your coding software, as it seems the newest coding guidelines may be outdated.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!
 
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