ICD-10 Coding for Sciatic Pain(M54.30, M54.31, M54.32, M54.4, M51.16)
Complete ICD-10-CM coding and documentation guide for Sciatic Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sciatic Pain
M54.3-M54.4Primary Range
Codes for sciatica and lumbago with sciatica
These codes are used to classify sciatica and related conditions, specifying laterality and association with low back pain.
Intervertebral disc disorders with radiculopathy
Used when sciatica is due to disc disorders, requiring specific imaging confirmation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.30 | Sciatica, unspecified side | Use when sciatica is present but the side is not specified. |
|
| M54.31 | Sciatica, right side | Use when sciatica is confirmed on the right side. |
|
| M54.32 | Sciatica, left side | Use when sciatica is confirmed on the left side. |
|
| M54.4 | Lumbago with sciatica | Use when both low back pain and sciatica are present. |
|
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region | Use when MRI confirms lumbar disc herniation causing sciatica. |
|
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 pain
Essential facts and insights about Sciatic Pain
Primary ICD-10-CM Codes for sciatic pain
Decision Criteria
documentation Criteria
- Document laterality and any underlying causes.
Applicable To
- Sciatica NOS
Clinical Validation Requirements
- Pain radiating below the knee
- Dermatomal numbness
Code-Specific Risks
- Lack of specificity may affect reimbursement.
Coding Notes
- Specify laterality whenever possible to avoid using unspecified codes.
M54.31 - Sciatica, right side
Use when sciatica is confirmed on the right side.
Applicable To
- Right-sided sciatica
Excludes
- Lumbago with sciatica (M54.4-)
- Sciatica due to intervertebral disc disorder (M51.1-)
Clinical Validation Requirements
- Right-sided pain radiating below the knee
- Positive straight leg raise test
Coding Notes
Always confirm laterality with clinical documentation.
M54.32 - Sciatica, left side
Use when sciatica is confirmed on the left side.
Applicable To
- Left-sided sciatica
Excludes
- Lumbago with sciatica (M54.4-)
- Sciatica due to intervertebral disc disorder (M51.1-)
Clinical Validation Requirements
- Left-sided pain radiating below the knee
- Positive straight leg raise test
Coding Notes
Always confirm laterality with clinical documentation.
M54.4 - Lumbago with sciatica
Use when both low back pain and sciatica are present.
Applicable To
- Low back pain with sciatica
Excludes
- Sciatica without low back pain (M54.3-)
Clinical Validation Requirements
- Low back pain with radiating leg pain
- Limited lumbar range of motion
Coding Notes
Document both low back pain and sciatica for accurate coding.
M51.16 - Intervertebral disc disorders with radiculopathy, lumbar region
Use when MRI confirms lumbar disc herniation causing sciatica.
Applicable To
- Lumbar disc herniation with radiculopathy
Excludes
- Sciatica without disc disorder (M54.3-)
Clinical Validation Requirements
- MRI showing lumbar disc herniation
- Radicular symptoms correlating with imaging
Coding Notes
Confirm disc pathology with imaging before coding.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Lumbago with sciatica
M54.4Intervertebral disc disorders with radiculopathy, lumbar region
M51.16Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.17Low back pain
M54.5Sciatica, right side
M54.31Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sciatic Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.30.
Impact
Clinical: Leads to less precise clinical data., Regulatory: Increases audit risk., Financial: May result in lower reimbursement.
Mitigation Strategy
Always document the affected side., Use specific ICD-10 codes for laterality.
Impact
Reimbursement: Incorrect sequencing may affect DRG assignment., Compliance: May trigger audits for incorrect coding., Data Quality: Leads to inaccurate clinical data representation.
Mitigation Strategy
Code the underlying cause first, such as M51.1- for disc disorders.
Impact
Reimbursement: Unspecified codes may reduce reimbursement., Compliance: Increases risk of audit., Data Quality: Reduces specificity in clinical data.
Mitigation Strategy
Ensure documentation specifies right, left, or unspecified.
Impact
High audit risk when using unspecified codes for sciatica.
Mitigation Strategy
Ensure documentation specifies laterality and underlying causes.
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 Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sciatic Pain
Use these documentation templates to ensure complete and accurate documentation for Sciatic Pain. These templates include all required elements for proper coding and billing.
Physical Therapy Evaluation
Specialty: Physical TherapyRequired Elements
- Subjective pain description
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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