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M54.50 vs S39.012

M54.50 (Low back pain, unspecified) compared with S39.012 (Strain of muscle, fascia and tendon of lower back), from the official CMS tabular data.

Summary

These codes should not be reported together because M54.50’s tabular entry lists S39.012 under Excludes1.

Official rule
What is different?

The conditions named, billing status and chapter.M54.50 is “Low back pain, unspecified”; S39.012 is “Strain of muscle, fascia and tendon of lower back”. S39.012 is a non-billable header; M54.50 is billable. M54.50 sits in M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99); S39.012 in S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88).

Registry fact

Can these codes be reported together?

No.M54.50’s entry carries an Excludes1 note covering S39.012: “low back strain (S39.012)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.M54.50’s tabular entry: “low back strain (S39.012)”. The note covers S39.012.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. S39.012 carries 7 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.S39.012 is a non-billable header, but M54.50 is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Excludes1 — generally not reported together

Excludes1 conflict

M54.50
Low back pain, unspecified
↔
S39.012
Strain of muscle, fascia and tendon of lower back

What we found

No — do not report together.M54.50 carries an Excludes1 note covering S39.012: “low back strain (S39.012)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

M54.50Low back pain, unspecifiedS39.012Strain of muscle, fascia and tendon of lower back
Billing statusBillableNon-billable header

Report instead: S39.012A, S39.012D, S39.012S

ClassificationM00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)
DefinitionLow back pain, unspecified is a billable ICD-10-CM diagnosis code (M54.50).Strain of muscle, fascia and tendon of lower back is a non-billable ICD-10-CM category code (S39.012).
7th character—The appropriate 7th character is to be added to each code from category S39
Includes
Loin pain
Lumbago NOS
injuries to the abdominal wall
injuries to the anus
injuries to the buttock
injuries to the external genitalia
Excludes1
intervertebral disc degeneration, lumbar region with discogenic back pain only (M51.360)
intervertebral disc degeneration, lumbosacral region with discogenic back pain only (M51.370)
low back strain (S39.012)
lumbago due to intervertebral disc displacement (M51.2-)
lumbago with sciatica (M54.4-)
psychogenic dorsalgia (F45.41)
current injury - see injury of spine by body region
discitis NOS (M46.4-)
—
Excludes2—
sprain of joints and ligaments of lumbar spine and pelvis (S33.-)
burns and corrosions (T20-T32)
effects of foreign body in anus and rectum (T18.5)
effects of foreign body in genitourinary tract (T19.-)
effects of foreign body in stomach, small intestine and colon (T18.2-T18.4)
frostbite (T33-T34)
insect bite or sting, venomous (T63.4)
Code also—
any associated open wound (S31.-)

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources