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ICD-10 Coding for Sciatica Pain(M54.3, M54.31, M54.32)

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

Also known as:

Sciatic Nerve PainRadicular PainLumbosacral Radiculopathy

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Related ICD-10 Code Ranges

Complete code families applicable to Sciatica Pain

M54.3-M54.32Primary Range

Sciatica codes including unspecified, right, and left side

These codes are used to document sciatica pain, specifying laterality when possible.

M51.1x

Intervertebral disc disorders with radiculopathy

Used when sciatica is due to disc disorders, providing more specificity.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
M54.3Sciatica, unspecified sideUse when sciatica is present but laterality is not specified.
  • Patient reports pain radiating from lower back to leg
  • Positive straight leg raise test
M54.31Sciatica, right sideUse when sciatica is documented on the right side.
  • Pain radiates from lower back to right leg
  • Positive SLR test on right side
M54.32Sciatica, left sideUse when sciatica is documented on the left side.
  • Pain radiates from lower back to left leg
  • Positive SLR test on 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 sciatica pain

Essential facts and insights about Sciatica Pain

The ICD-10 code for unspecified sciatica pain is M54.3. For right-sided sciatica, use M54.31, and for left-sided sciatica, use M54.32.

Primary ICD-10-CM Codes for sciatica pain

M54.3
Sciatica, unspecified side
Non-billable Code

Decision Criteria

documentation Criteria

  • Presence of radicular pain without specified laterality.

Applicable To

  • Sciatic nerve pain

Excludes

  • Lumbago with sciatica (M54.4x)

Clinical Validation Requirements

  • Patient reports pain radiating from lower back to leg
  • Positive straight leg raise test

Code-Specific Risks

  • Risk of under-documentation if laterality is known but not coded.

Coding Notes

  • Ensure documentation supports the use of this code by confirming sciatica symptoms.
View Full Code Details

Ancillary Codes

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

Intervertebral disc disorders with radiculopathy

M51.1x
Use when sciatica is due to disc herniation.

Intervertebral disc disorder with radiculopathy, lumbar region

M51.17
Use if sciatica is due to lumbar disc disorder.

Intervertebral disc disorder with radiculopathy, lumbar region

M51.16
Use if sciatica is due to lumbar disc disorder.

Differential Codes

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

Low back pain

M54.5
Use when sciatica is not present.

Sciatica, left side

M54.32
Use when sciatica is documented on the left side.

Sciatica, right side

M54.31
Use when sciatica is documented on the right side.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Sciatica 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: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims or reduced reimbursement.

Mitigation Strategy

Ensure thorough neurological examination is documented., Use templates to guide comprehensive documentation.

Impact

Reimbursement: May result in lower reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.

Mitigation Strategy

Always use M54.31 or M54.32 if laterality is specified.

Impact

Frequent use of M54.3 without specifying laterality.

Mitigation Strategy

Educate providers on the importance of documenting laterality.

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 Sciatica Pain, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Sciatica Pain

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

Chiropractic SOAP Note

Specialty: Chiropractic

Required Elements

  • Subjective pain description
  • Objective physical exam findings
  • Assessment with ICD-10 code
  • Plan for treatment

Example Documentation

**S (Subjective):** 'Patient reports 8/10 shooting pain from lower back to right calf, worsened by sitting.' **O (Objective):** Positive right SLR at 30°, reduced right ankle reflex, tenderness at L5-S1. **A (Assessment):** M54.31 (Sciatica, right side) due to suspected L5 radiculopathy. **P (Plan):** Spinal manipulation, nerve gliding exercises.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has back pain.
Good Documentation Example
Patient reports sharp pain radiating from L5-S1 to left posterior thigh, positive SLR at 45°, MRI shows L5 nerve root compression.
Explanation
The good example provides specific details about the pain, its location, and supporting diagnostic tests, which are necessary for accurate coding.

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

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