ICD-10 Coding for Buttock Pain(M54.3, M79.6)
Complete ICD-10-CM coding and documentation guide for Buttock Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Buttock Pain
M54.3-M54.5Primary Range
Dorsalgia, including sciatica and low back pain
Includes codes for sciatica and low back pain, which are common causes of buttock pain.
Pain in limb, including piriformis syndrome
Covers myofascial pain conditions like piriformis syndrome that can cause buttock pain.
Chronic pain, not elsewhere classified
Used for chronic pain management scenarios related to buttock pain.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.3 | Sciatica | Use when buttock pain is due to nerve root compression, confirmed by imaging. |
|
| M79.6 | Pain in limb | Use when buttock pain is due to piriformis syndrome, confirmed by physical exam. |
|
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: ICD-10 code for buttock pain
Essential facts and insights about Buttock Pain
Primary ICD-10-CM Codes for buttock pain
Decision Criteria
clinical Criteria
- Presence of dermatomal pain pattern and imaging confirmation
Applicable To
- Pain radiating from lower back to buttock and leg
Excludes
- Piriformis syndrome (M79.6)
Clinical Validation Requirements
- MRI showing nerve root compression
- Positive straight leg raise test
Code-Specific Risks
- Misdiagnosing piriformis syndrome as sciatica
Coding Notes
- Ensure documentation specifies nerve involvement and imaging results.
M79.6 - Pain in limb
Use when buttock pain is due to piriformis syndrome, confirmed by physical exam.
Applicable To
- Piriformis syndrome
Excludes
- Sciatica (M54.3)
Clinical Validation Requirements
- Physical exam showing tenderness over piriformis
- Pain with resisted hip abduction
Coding Notes
Document specific muscle tenderness and response to physical tests.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain due to trauma
G89.21Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Buttock Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.3.
Impact
Clinical: Misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential denial of claims due to insufficient documentation.
Mitigation Strategy
Use specific terms like 'radiating pain' or 'burning sensation'., Include imaging or test results when available.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use S39.013 for strain-related buttock pain.
Impact
Use of G89 codes without proper documentation.
Mitigation Strategy
Ensure documentation includes pain duration and management details.
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 Buttock Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Buttock Pain
Use these documentation templates to ensure complete and accurate documentation for Buttock Pain. These templates include all required elements for proper coding and billing.
Chronic Sciatica with Imaging Confirmation
Specialty: OrthopedicsRequired Elements
- Pain description and radiation
- Imaging results
- Physical exam findings
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Buttock Pain? Ask your questions below.