Wiki M54.51 - Vertebrogenic low back pain

[SticeOrbeck12]

I need information regarding a new code for back pain; M54.51 Vertebrogenic low back pain. Is there any guidelines in order to use this code?

I read a notation of this:
Vetebrogenic back pain is specifying the origin of the pain from the vertebrae or spine. However, this code is to distinguish specific “lower back vertebral endplate pain” and would not be used for simple “spine-related”. This would be a covered diagnosis but one with specificity of a particular condition. Spine related conditions such as sprain, strain, radiculopathy, disc, etc. would not be appropriate for this code as they have a more specified code. Veterbrogenic means coming from the bone itself.

Any information is greatly appreciated! Thank you.

 

[amyjph]

It would have to be specifically documented in the medical record like anything else. The provider would have to specify the origin of the low back pain as coming from the bone and not a disc or soft tissue (DDD, herniation, muscle, etc.) for example. You would look for this as a key term: vertebral body endplate

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297155/

https://www.spineuniverse.com/conditions/back-pain/low-back-pain/chronic-low-back-vertebrogenic-pain-involves-spinal-vertebral

https://www.hjrosscompany.com/billing-coding-m54-51-vertebrogenic-low-back-pain/

https://www.webpt.com/blog/m54-5-is-no-more-the-scoop-on-icd-10s-low-back-pain-code-change/

https://www.apta.org/news/2021/09/29/icd-10-update

 

[jkyles]

The code went into effect in 2021 and is associated with intraosseous basivertebral denervation.
Here is part of a description for the dx code from SelectCoder (emphasis added):

Vertebrogenic low back pain is a specific subtype of low back pain identified by Modic endplate changes on MRI. Modic changes are alterations in the bone marrow’s signal intensity in vertebral body endplates. Endplate degeneration can be identified from the presence of edema (type I), fat (type 2) or sclerosis (type 3).