The diagnosis code M54.2, categorized under the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), is specifically designated for Cervicalgia, commonly known as neck pain. This code is crucial for healthcare professionals for accurate diagnosis, medical billing, and statistical tracking of neck pain conditions. Within the realm of medical coding, understanding the nuances of codes like M54.2 is essential for proper documentation and reimbursement.
Key Features of ICD-10-CM Code M54.2
ICD-10-CM code M54.2 holds several important characteristics that define its application and limitations in medical practice. These features are critical for both clinical diagnosis and administrative processes.
Billable/Specific Code Status
M54.2 is classified as a billable/specific code. This designation is significant because it means that M54.2 is detailed enough to be used directly on medical claims for reimbursement purposes. Unlike some broader or less specific codes, M54.2 provides the necessary granularity for describing a patient’s condition of cervicalgia.
Effective Date
The 2025 edition of ICD-10-CM M54.2 became effective on October 1, 2024. It’s vital to note the effective date of ICD-10-CM codes, as updates and revisions are made annually. Using the correct, current version of the code ensures compliance and accurate billing. The code M54.2 itself has been consistently used since the inception of the non-draft ICD-10-CM in 2016, with no changes through the 2025 edition, indicating its stable and well-defined nature within the coding system.
Type 1 Excludes
M54.2 has a Type 1 Excludes note associated with it. In ICD-10-CM, a Type 1 Excludes note is a “pure excludes” directive. It explicitly states “not coded here,” meaning that the conditions listed under the Excludes1 note should never be coded together with M54.2. This type of exclusion is used when two conditions are mutually exclusive, such as congenital versus acquired forms of the same condition, ensuring accurate and non-redundant coding.
Annotations and Back-references
Within the ICD-10-CM system, M54.2 is referenced by various annotations. These annotation back-references point to codes that include annotations relevant to M54.2. These annotations can be of several types, including: Applicable To, Code Also, Code First, Excludes1, Excludes2, Includes, Note, or Use Additional annotations. These cross-references are valuable for coders to understand the broader context and related coding guidelines when using M54.2.
Synonyms for M54.2: Describing Neck Pain
Understanding the synonyms associated with M54.2 can provide a more comprehensive grasp of what this diagnosis code encompasses. These approximate synonyms offer different ways neck pain might be described in clinical settings:
- Chronic neck pain
- Chronic neck pain for greater than 3 months
- Chronic neck pain greater than 3 months
- Neck pain
- Neck pain less than 3 months, acute
- Neck pain, chronic
- Pain in cervical spine for less than 3 months
- Pain in cervical spine for more than 3 months
- Pain, cervical (neck) spine, acute less than 3 months
- Pain, cervical (neck), chronic, more than 3 months
These synonyms highlight that M54.2 can be used for both acute (less than 3 months) and chronic (more than 3 months) neck pain, although the term “cervicalgia” itself often implies a more persistent or chronic condition.
Clinical Information Related to Cervicalgia
Cervicalgia, as defined by the clinical information associated with M54.2, is characterized by a marked discomfort sensation in the neck area. It refers to discomfort or more intense pain localized to the cervical region, typically in the posterior or lateral aspects of the neck. This clinical description helps to differentiate cervicalgia from other types of pain and clarifies the anatomical location of the pain.
Diagnostic Related Group (MS-DRG)
ICD-10-CM M54.2 is grouped within Diagnostic Related Groups (MS-DRG v42.0). DRGs are a system to classify hospital cases into one of originally 467 groups, later expanded to more, based on diagnoses, procedures, age, sex, and the presence of complications or comorbidities. This grouping is used for hospital reimbursement and quality benchmarking. The MS-DRG assignment for M54.2 indicates how cases of cervicalgia are categorized for these purposes.
Code History of M54.2
The code history of M54.2 is straightforward, showing its consistent use over the years:
- 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
- 2017-2025: No change
This stable code history reinforces the established nature of M54.2 within the ICD-10-CM coding system.
ICD-10-CM Codes Adjacent to M54.2
To provide context within the ICD-10-CM manual, it’s helpful to see the codes adjacent to M54.2:
- M54.1 Radiculopathy
- M54.3 Sciatica
- M54.4 Lumbago with sciatica
- M54.5 Low back pain
These adjacent codes represent related conditions affecting the spine and back, illustrating that M54.2 for cervicalgia is part of a broader category of spinal pain conditions within the ICD-10-CM classification.
Reimbursement and M54.2
It’s important to remember that reimbursement claims with a date of service on or after October 1, 2015, require the use of ICD-10-CM codes. M54.2, being a billable and specific code, is essential for accurately documenting and billing for diagnoses of cervicalgia in healthcare settings within the United States. Using the correct diagnosis code like M54.2 is paramount for healthcare providers to receive appropriate compensation for services rendered.
In conclusion, M54.2 is the designated ICD-10-CM diagnosis code for Cervicalgia. Its specific nature, billable status, and clear clinical definition make it a vital tool for medical professionals in diagnosing, documenting, and billing for neck pain conditions. Understanding the nuances of M54.2, including its synonyms, exclusions, and place within the broader ICD-10-CM system, is crucial for accurate and effective medical coding practices.
