ED Coding and Reimbursement Alert

Reader Questions:

Get Specific When Coding Sciatica

Question: The ED physician diagnosed a patient with sciatica. Which code applies?

Tennessee Subscriber

Answer: Since ICD-10-CM offers different codes for sciatica depending upon the body’s affected side, you must check your provider’s medical documentation and confirm where the patient’s sciatica was located. You have these codes to look to for a sciatica diagnosis:

  • M54.30 (Sciatica, unspecified side)
  • M54.31 (Sciatica, right side)
  • M54.32 (Sciatica, left side)

Coding example: The physician documents that the patient has sciatica on her left side. You would report M54.32 for this condition.

If your provider documents lumbago along with the patient’s sciatica, you will have different codes to choose from. When looking at these codes, you must know the side of the patient’s body affected to pick the appropriate code. You can look to the following codes for lumbago with sciatica:

  • For lumbago with sciatica on the right side, you should report M54.41 (Lumbago with sciatica, right side).
  • For lumbago with sciatica on the left side, you should report M54.42 (Lumbago with sciatica, left side).
  • When your physician does not document which side the symptoms were present, you should report code M54.40 (Lumbago with sciatica, unspecified side).