ICD-10 Coding for Sciatica, Right Side(M54.31, M54.41)
Complete ICD-10-CM coding and documentation guide for Sciatica, Right Side. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sciatica, Right Side
M54.3-M54.4Primary Range
Dorsalgia
This range includes codes for sciatica and related conditions affecting the back and spine.
Intervertebral disc disorders with radiculopathy
Used when sciatica is secondary to disc disorders.
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 for isolated right-sided sciatica without underlying spinal pathology. |
|
| M54.41 | Lumbago with sciatica, right side | Use when low back pain coexists with right-sided 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 right-sided sciatica
Essential facts and insights about Sciatica, Right Side
Primary ICD-10-CM Codes for sciatica right side
Decision Criteria
clinical Criteria
- Presence of right-sided radicular pain and positive SLR test
documentation Criteria
- Specific mention of 'right-sided sciatica' in clinical notes
Applicable To
- Right-sided sciatica
Excludes
- Lumbago with sciatica (M54.41)
Clinical Validation Requirements
- Positive straight leg raise test
- Pain radiating below the knee
- Neurological deficits on the right side
Code-Specific Risks
- Using unspecified codes when laterality is known
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
M54.41 - Lumbago with sciatica, right side
Use when low back pain coexists with right-sided sciatica.
Applicable To
- Right-sided lumbago with sciatica
Excludes
- Sciatica without lumbago (M54.31)
Clinical Validation Requirements
- Coexisting low back pain with right-sided sciatica
Coding Notes
Ensure documentation specifies both lumbago and sciatica.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Intervertebral disc disorder with radiculopathy, lumbar region
M51.16Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sciatica, Right Side to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.31.
Impact
Clinical: Leads to inaccurate diagnosis and treatment., Regulatory: Increases risk of audits., Financial: Potential for claim denials.
Mitigation Strategy
Always include laterality in documentation., Use templates that prompt for specific details.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Increases audit risk due to lack of specificity., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always document and code the specific side affected.
Impact
Using unspecified codes when specific codes are available.
Mitigation Strategy
Ensure documentation supports specific code selection.
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, Right Side, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sciatica, Right Side
Use these documentation templates to ensure complete and accurate documentation for Sciatica, Right Side. These templates include all required elements for proper coding and billing.
Right-sided sciatica with disc herniation
Specialty: OrthopedicsRequired Elements
- History of present illness
- Physical examination findings
- Diagnostic imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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