Intractable Back Pain ICD-10-CM Codes

What are Intractable Back Pain ICD-10-CM Codes?

As of 2025, no ICD-10-CM diagnosis code explicitly uses the term “intractable back pain.” In this context, "intractable" refers to chronic pain that persists for greater than 3 months and does not respond to conventional treatments. While this term is clinically recognized, it is not coded separately in the ICD-10-CM system.

The most appropriate ICD-10-CM diagnosis code for back pain that is chronic, generalized, or unresponsive to treatment is:

• M54.9 – Dorsalgia, unspecified

This code applies to localized pain, unspecified type, or generalized back pain where the acute pain becomes chronic, difficult to control, and not directly linked to a structural condition like intervertebral disc degeneration lumbar, disc degeneration lumbosacral region issues, or other intervertebral disc degeneration disorders. M54.9 remains valid and billable for both inpatient and outpatient encounters.

The 2025 ICD-10-CM update introduced more specific codes for low back pain, replacing the outdated M54.5:

• M54.50 – Low back pain, unspecified
• M54.51 – Vertebrogenic low back pain (related to vertebral endplate changes or discogenic back pain)
• M54.59 – Other low lumbar back pain (e.g., low back strain, facet joint dysfunction, muscular origin)

These codes offer refined classification, particularly for cases involving intervertebral disc degeneration, disc disc degeneration lumbar region is displaced, or pain due to intervertebral disc displacement. However, they do not replace M54.9 when the diagnosis involves pain, unspecified type code, or intractable, generalized pain with no specific location or structural cause.

Which Intractable Back Pain ICD-10-CM Codes are billable?

Yes. When a patient presents with intractable back pain that is not clearly linked to discogenic causes, radiculopathy, or specific spinal segments like the lumbar region or lumbosacral region, M54.9 is the best choice. It reflects chronic low back pain, pain NOS, or pain for greater than 3 months that remains unexplained after diagnostic imaging or intervention.

This code is especially useful for cases of:

• Back pain without radiculopathy
• Pain low in the lumbar region without localization
• Chronic back pain not responsive to treatment
• Pain related to psychological factors or exclusively related to psychological factors
• Pelvic and perineal pain or loin pain when no clear musculoskeletal source is found

Clinical information

Intractable back pain is defined as persistent, severe back pain—usually in the lumbar region or lumbosacral region—that lasts longer than 3 months and does not improve with standard treatment protocols. It can be due to mechanical dysfunction, nerve irritation, or psychological stressors, even without a specific structural finding like intervertebral disc degeneration lumbosacral.

This kind of chronic low back pain often coexists with:

• Leg pain or lower extremity pain
• Foot pain (referred from lumbar nerves)
• Abdominal pain mimicking spinal pathology
• Joint pain or shoulder pain in compensatory areas

The pain may be acute or chronic, can evolve from acute back pain or acute low back pain, and requires pain management strategies. It may also be exacerbated by conditions like lumbago with sciatica or lumbago due to intervertebral disc disorders, but if not definitively diagnosed, M54.9 remains the default code.

Synonyms include

• Backache
• Backache with radiation
• Discogenic pain
• Disorder characterized by back pain
• Exacerbation of backache
• Pain in spine