Neurology & Pain Management Coding Alert

Your options will get more specific under ICD-10. 

When your physician diagnoses sciatica, you currently have a single ICD-9 code to report: 724.3 (Sciatica). Coding notes explain that 724.3 applies to neuralgia or neuritis of the sciatic nerve, but should not be separately reported when sciatica is due to diagnoses such as collapsed vertebra (733.x), intervertebral disc disorders (722.x), or spondylosis (721.x). 

Definition: The term “sciatica” describes a symptom rather than a specific disease. Sciatica is pain caused by compression of a spinal nerve root in the lower back, often due to herniation of an intervertebral disc. The pain affects the back, hip, and outer side of the leg and can range from feeling like a bad leg cramp to being so excruciating that the patient can barely sit or stand. 

ICD-10 change: Shifting to ICD-10 in October 2015 will expand your options for assigning a diagnosis for sciatica. The codes will specify the affected side as well as include whether the condition exists in conjunction with lumbago (low back pain).  

Diagnoses from ICD-10 will include: 

• M54.30 – Sciatica, unspecified site 
  
• M54.31 – Sciatica, right side 
  
• M54.32 – Sciatica, left side 
  
• M54.40 – Lumbago with sciatica, unspecified site 
  
• M54.41 – Lumbago with sciatica, right side 
  
• M54.42 – Lumbago with sciatica, left side. 
  

Coding tips: You always want to 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 will depend on laterality under ICD-10. Any details your provider notes regarding the affected side and whether 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 providers remember to document that detail. 

The ICD-10 guidelines also include instructions regarding bilateral conditions. According to Section I B.13, “… If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right sides.” You’ll need to remember this because ICD-10 does not include specific bilateral codes for sciatica or lumbago with sciatica. 

Did you know? 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.