M54.5 vs R52
M54.5 (Low back pain) compared with R52 (Pain, unspecified), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. R52 carries an Excludes1 note covering M54.5: “lumbar region pain (M54.5-)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
No — do not report together. R52 carries an Excludes1 note covering M54.5: “spine pain (M54.-)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| M54.5Low back pain | R52Pain, unspecified | |
|---|---|---|
| Billing status | Non-billable header | Billable |
| Classification | M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) | R00-R99 — Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) |
| Definition | Low back pain is a non-billable ICD-10-CM category code (M54.5). | Pain, unspecified is a billable ICD-10-CM diagnosis code (R52). |
| Includes | — | Acute pain NOS Generalized pain NOS Pain NOS |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources