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ICD-10 Coding for Bilateral Intermittent Sciatica(M54.31, M54.32)

Complete ICD-10-CM coding and documentation guide for Bilateral Intermittent Sciatica. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Bilateral SciaticaIntermittent Sciatic Pain

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Related ICD-10 Code Ranges

Complete code families applicable to Bilateral Intermittent Sciatica

M54.3-Primary Range

Sciatica

This range includes codes for sciatica, specifying laterality and is used for coding bilateral cases.

M51.1-

Intervertebral disc disorders with radiculopathy

Used when sciatica is caused by a herniated disc.

M48.0-

Spinal stenosis

Applicable when spinal stenosis is the underlying cause of sciatica.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
M54.31Sciatica, right sideUse when sciatica symptoms are present on the right side.
  • Documented right-sided leg pain radiating from the lower back
  • Positive straight leg raise test on the right side
M54.32Sciatica, left sideUse when sciatica symptoms are present on the left side.
  • Documented left-sided leg pain radiating from the lower back
  • Positive straight leg raise test on the left side

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: How do you code bilateral intermittent sciatica?

Essential facts and insights about Bilateral Intermittent Sciatica

For bilateral intermittent sciatica, use ICD-10 codes M54.31 and M54.32 together, ensuring documentation specifies 'bilateral' and 'intermittent' symptoms.

Primary ICD-10-CM Codes for bilateral intermittent sciatica

M54.31
Sciatica, right side
Billable Code

Decision Criteria

clinical Criteria

  • Presence of right-sided leg pain with nerve root involvement

Applicable To

  • Right-sided sciatica

Excludes

Clinical Validation Requirements

  • Documented right-sided leg pain radiating from the lower back
  • Positive straight leg raise test on the right side

Code-Specific Risks

  • Incorrectly coding as unspecified when laterality is known

Coding Notes

  • Ensure laterality is documented to avoid unspecified coding.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Intervertebral disc disorder with radiculopathy, lumbar region

M51.16
Use when a herniated disc is the cause of sciatica.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Low back pain without sciatica

M54.5
Use when there is low back pain without radiating leg pain.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Bilateral Intermittent Sciatica to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.31.

Impact

Clinical: Leads to inadequate treatment planning., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for denied claims or reduced reimbursement.

Mitigation Strategy

Use templates that prompt for laterality., Educate staff on the importance of detailed documentation.

Impact

Reimbursement: May result in lower reimbursement due to unspecified coding., Compliance: Non-compliance with coding guidelines for laterality., Data Quality: Reduces data accuracy for patient records.

Mitigation Strategy

Code both M54.31 and M54.32 for bilateral sciatica.

Impact

Using unspecified codes when laterality is documented.

Mitigation Strategy

Regular audits of clinical documentation to ensure specificity.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Bilateral Intermittent Sciatica, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Bilateral Intermittent Sciatica

Use these documentation templates to ensure complete and accurate documentation for Bilateral Intermittent Sciatica. These templates include all required elements for proper coding and billing.

Orthopedic Clinic Visit

Specialty: Orthopedics

Required Elements

  • Pain location and radiation
  • Duration and frequency
  • Aggravating and relieving factors
  • Physical exam findings

Example Documentation

Patient presents with intermittent bilateral sciatica, radiating to posterior thighs, worsened by sitting.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has sciatica.
Good Documentation Example
Intermittent bilateral sciatica with radiation to posterior thighs, alternating sides, aggravated by prolonged sitting.
Explanation
The good example specifies laterality, intermittency, and aggravating factors, supporting accurate coding.

Need help with ICD-10 coding for Bilateral Intermittent Sciatica? Ask your questions below.

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