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Ask Ava which code to use

Ava checks the South African ICD-10 table before she answers, so you get a code that's valid on a claim here. Your first two questions are free, and you don't need an account.

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Don't type a patient's name or ID number. Privacy policy.

An answer you can put on a claim

South Africa uses the WHO edition of ICD-10. US reference sites use a different one, and their codes can be rejected on a claim here.

Is M54.5 billable in South Africa?

No. M54.5 isn't valid for clinical use or as a primary code in South Africa, so you need one of the fifth-character codes in the M54.5 family, chosen by where the pain is.

Use M54.56 for the lumbar region and M54.59 only when the site isn't specified. You must code to the highest level of specificity available (SA ICD-10 Coding Standards).

Codes in this answer

  • M54.50 Low back pain, multiple sites in spine ICD-10
  • M54.55 Low back pain, thoracolumbar region ICD-10
  • M54.56 Low back pain, lumbar region ICD-10
  • M54.57 Low back pain, lumbosacral region ICD-10
  • M54.58 Low back pain, sacral and sacrococcygeal region ICD-10
  • M54.59 Low back pain, site unspecified ICD-10
A real answer from Ava, shortened.

  1. A confirmed code

    A code in violet is one Ava found in the South African table for your question. A code she didn't find stays plain.

  2. The rule she applied

    If a coding standard decides the answer, she tells you which one.

  3. Every code, with its title

    The codes she found are listed under the answer, each with its full title.

Where Ava's answers come from

Ava looks each question up in these sources before she answers.

The South African ICD-10 table
Every diagnosis code, about 41,000 of them, with what a claim is checked against: whether the code is valid, whether the code can be the primary diagnosis, and any age or gender limit on the code.
The South African coding standards
The rules for coding a claim here, such as coding to the fourth or fifth character and adding an external cause to an injury. Ava tells you which rule she's applying.
Procedure tariffs
Tariff codes for procedures, and which ones you can claim together.

Questions about Ask Ava

Is Ask Ava free?

Your first two questions are free, with no account. To keep asking, create a free Practor account.

Is this medical or billing advice?

No. Ava explains codes and the rules for using them. You're responsible for the codes you submit, and a patient's medical insurer can have rules of its own.

Does Ava use US codes?

No. South Africa uses the WHO edition of ICD-10, and Ava answers from that. If you ask about a US code, she'll say so and give you the South African one.

What happens to what I type?

Don't type a patient's name or ID number. Practor removes ID numbers, phone numbers and email addresses before a question is saved, and deletes questions after 180 days.

Can I trust the codes?

The codes listed under an answer are ones Ava found in the South African table for your question, with their full titles. Check the title matches what you're coding.

Can I share an answer?

Not from the chat. Our team checks some answers and publishes them on practor.app, and each one has its own link you can share.

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