ICD-10 Coding for Low Back Pain with Sciatica(M54.31, M54.32, M54.41, M54.42)
Complete ICD-10-CM coding and documentation guide for Low Back Pain with Sciatica. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Low Back Pain with Sciatica
M54.3-M54.4Primary Range
Codes for sciatica and lumbago with sciatica
These codes are used to classify sciatica and low back pain with sciatica, specifying laterality and presence of lumbago.
Intervertebral disc disorders with radiculopathy
Used when sciatica is due to a disc disorder, providing additional specificity.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.31 | Sciatica, right side | Use when sciatica is present on the right side without significant low back pain. |
|
| M54.32 | Sciatica, left side | Use when sciatica is present on the left side without significant low back pain. |
|
| M54.41 | Lumbago with sciatica, right side | Use when both low back pain and sciatica are present on the right side. |
|
| M54.42 | Lumbago with sciatica, left side | Use when both low back pain and sciatica are present 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: ICD-10 code for low back pain with sciatica
Essential facts and insights about Low Back Pain with Sciatica
Primary ICD-10-CM Codes for low back pain with sciatica
Decision Criteria
clinical Criteria
- Presence of right-sided leg pain with neurological signs
Applicable To
- Right-sided sciatica
Excludes
- Lumbago with sciatica (M54.41)
Clinical Validation Requirements
- Radiating leg pain on the right side
- Positive straight leg raise test
Code-Specific Risks
- Misclassification if laterality is not documented
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
M54.32 - Sciatica, left side
Use when sciatica is present on the left side without significant low back pain.
Applicable To
- Left-sided sciatica
Excludes
- Lumbago with sciatica (M54.42)
Clinical Validation Requirements
- Radiating leg pain on the left side
- Positive straight leg raise test
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
M54.41 - Lumbago with sciatica, right side
Use when both low back pain and sciatica are present on the right side.
Applicable To
- Right-sided low back pain with sciatica
Excludes
- Sciatica without low back pain (M54.31)
Clinical Validation Requirements
- Low back pain with radiating leg pain on the right side
- Positive straight leg raise test
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
M54.42 - Lumbago with sciatica, left side
Use when both low back pain and sciatica are present on the left side.
Applicable To
- Left-sided low back pain with sciatica
Excludes
- Sciatica without low back pain (M54.32)
Clinical Validation Requirements
- Low back pain with radiating leg pain on the left side
- Positive straight leg raise test
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Low Back Pain with 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: Inaccurate treatment plans, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Train staff on documentation standards, Use checklists for patient assessments
Impact
Reimbursement: May lead to claim denials due to incorrect coding., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data on patient conditions and treatments.
Mitigation Strategy
Use M54.3- or M54.4- codes when sciatica is documented.
Impact
Using unspecified codes when laterality is documented.
Mitigation Strategy
Implement documentation audits and training.
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 Low Back Pain with Sciatica, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Low Back Pain with Sciatica
Use these documentation templates to ensure complete and accurate documentation for Low Back Pain with Sciatica. These templates include all required elements for proper coding and billing.
Patient with low back pain and sciatica
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination
- Imaging results
- Diagnosis
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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