ICD 10 Coding Alert

Don’t forget to check whether sciatica is accompanied by lumbago.

Brush up on the both the basics and subtleties of coding sciatica correctly with these expert tips.

Make Sure Sciatica is the Dx

Question 1:  What is sciatica?

Answer 1: Sciatica means the patient presents with compression of a lumbar nerve root. The patient will typically complain of symptoms of leg pain. You may also spot that your physician documented tingling, numbness, or weakness. These symptoms may typically originate in the lower back and then radiate through the buttock and down the sciatic nerve in the leg.

“However, the term sciatica is applied to radiating leg pain of nerve origin that typically travels along a nerve root pattern, which may or may not follow the distribution of the sciatic nerve,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Sciatic nerve defined: The sciatic nerve is one of the major nerves of the lower limb and is the largest nerve in the body. It originates from the L4-S3 spinal nerves and extends through the buttock area under the Piriformis muscle to provide motor innervation to the posterior thigh muscles and indirectly motor and sensory innervation to the lower leg and foot. The pain of sciatica is sometimes referred to as sciatic nerve pain.

Know Location of Sciatica

Question 2:  How do I know which ICD-10 code to report for the sciatica?

Answer 2: To submit the correct diagnosis code, you should always specify where the sciatica is occurring. You must check the laterality and report from the following codes:

• 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 his right side. You would report M54.31 for this condition.

Determine Whether Lumbago Documented, too

Question 3: What ICD-10 codes should we report if the physician documented a backache (lumbago) along with leg pain and tingling?

Answer 3: If the physician also documented lumbago along with the leg pain and tingling, you must first see on which side the symptoms are documented. For lumbago with sciatica on the right side, report M54.41 (Lumbago with sciatica, right side). For the same symptoms on the left side, you should report code 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).

“Note that not all patients with sciatica and leg pain have concurrent back pain. The causes of each are not always related,” Przybylski says.

Top tip: Encourage your providers to document a patient’s condition as thoroughly as possible so you can select the most appropriate diagnosis. This mindset is especially important for sciatica and other diagnoses that depend on laterality. Any details your provider notes regarding the affected side and if other symptoms also are present (such as lumbago) will help you code more accurately. Including a note of “laterality” beside the sciatica diagnosis on your superbill might help your providers remember to document this detail.

Remember to Check Excludes1 Notes

Question 4: Are there any Excludes1 notes under the M54.3- (Sciatica) category?

Answer 4: Yes. According to an Excludes1 note under category M54.3-, you should not report these sciatica codes with lesion of sciatic nerve (G57.0), sciatica due to intervertebral disc disorder (M51.1-), or sciatica with lumbago (M54.4-).