ICD-10 Coding for Sciatic Nerve Pain(M54.3, M54.4x, M51.16)
Complete ICD-10-CM coding and documentation guide for Sciatic Nerve Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sciatic Nerve Pain
M54.3-M54.4Primary Range
Dorsalgia and sciatica codes
These codes cover sciatica with and without low back pain, which are the primary conditions associated with sciatic nerve pain.
Intervertebral disc disorders with radiculopathy
This range includes disc-related sciatica, which is a common underlying cause of sciatic nerve 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 sciatica is present without any low back pain or disc pathology. |
|
| M54.4x | Lumbago with sciatica | Use when sciatica is accompanied by low back pain. |
|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when sciatica is due to a confirmed disc herniation. |
|
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 sciatic nerve pain
Essential facts and insights about Sciatic Nerve Pain
Primary ICD-10-CM Codes for sciatic nerve pain
Decision Criteria
clinical Criteria
- Absence of low back pain and negative imaging for disc pathology.
Applicable To
- Sciatica without low back pain
Clinical Validation Requirements
- Negative MRI for disc pathology
- No motor deficits
- Negative straight leg raise (SLR) test
Code-Specific Risks
- Risk of under-documenting underlying causes leading to incorrect coding.
Coding Notes
- Ensure documentation specifies absence of low back pain.
M54.4x - Lumbago with sciatica
Use when sciatica is accompanied by low back pain.
Applicable To
- Sciatica with low back pain
Excludes
- Sciatica without low back pain (M54.3)
Clinical Validation Requirements
- Lumbago with leg radiation
- Tenderness at lumbar spine
- Limited range of motion
Coding Notes
Document both sciatica and low back pain clearly.
M51.16 - Intervertebral disc disorders with radiculopathy, lumbar region
Use when sciatica is due to a confirmed disc herniation.
Applicable To
- Disc herniation with sciatica
Excludes
- Sciatica without disc disorder (M54.3)
Clinical Validation Requirements
- MRI-confirmed disc herniation
- Dermatomal weakness
- EMG-confirmed radiculopathy
Coding Notes
Ensure MRI findings are documented.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sciatic Nerve 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: Inaccurate clinical records, Regulatory: Potential for audit issues, Financial: Reduced reimbursement rates
Mitigation Strategy
Always document the affected side, Use templates that prompt for laterality
Impact
Reimbursement: Denial risk: $1,200-$3,500 per claim, Compliance: Non-compliance with ICD-10 coding rules, Data Quality: Inaccurate clinical data representation
Mitigation Strategy
Code M51.16 first when disc pathology is present.
Impact
Coding sciatica without identifying disc pathology can lead to audits.
Mitigation Strategy
Ensure thorough documentation of imaging and clinical findings.
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 Sciatic Nerve Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sciatic Nerve Pain
Use these documentation templates to ensure complete and accurate documentation for Sciatic Nerve Pain. These templates include all required elements for proper coding and billing.
Sciatica with disc herniation
Specialty: NeurologyRequired Elements
- Pain location and quality
- Imaging results
- Neurological findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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