FY2027
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Excludes1 pair

M54.9 vs R52

M54.9 and R52 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

The official note, declared on R52
back pain (M54.9)
M54.9

Dorsalgia, unspecified

BillableUnspecified
Chapter 13
Diseases of the musculoskeletal system and connective tissue
Section
M50-M54
Use when the record says
  • Backache NOS
  • Back pain NOS
Indexed under
  • Backache (postural)
  • Dorsalgia
  • Pain › back (postural)
  • Pain › spine
R52

Pain, unspecified

BillableUnspecified
Chapter 18
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
Section
R50-R69
Use when the record says
  • Acute pain NOS
  • Generalized pain NOS
  • Pain NOS
Indexed under
  • Pain (s)
  • Pain › acute
  • Pain › generalized NOS

These two codes sit in different chapters of the Tabular List, which is usually the clearest signal that they describe different underlying processes rather than different degrees of the same one.

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027