Neurosurgery Coding Alert

Don’t forget to confirm lumbago with sciatica.

ICD-10 will offer more specific codes for sciatica. There isn’t a one-to-one match for ICD-9 options because laterality will guide your diagnosis reporting in 2015. Check out these coding equivalents for sciatica. 

What is sciatica? Sciatica means the patient presents with compression to the sciatic nerve. 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 back of 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, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Spot the correct code: To report the correct code, you should specify where the sciatica is occurring. 

ICD-9-CM Code: Currently, you report this condition with ICD-9 code 724.3 (Sciatica). 

ICD-10-CM Code: ICD-10 will offer benefits to coders. “The benefit is anticipated as the ICD-10 codes are much more specific,” says Lisa Fisher Blackmon, CPC, Surgical Coder, Integrated MD Solutions, Inc., Daphne, AL. When the ICD-10 diagnosis codes are implemented, you check the laterality and report from the following codes instead:

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

Confirm the lumbago: Check if your physician also documented back ache (lumbago) along with leg pain and tingling. In this case again, you ascertain which side the symptoms are documented. For lumbago with sciatica on the right side, you submit ICD-10 code M54.41 (Lumbago with sciatica, right side) and for the same on the left side, you submit code M54.42 (Lumbago with sciatica, left side). When your physician does not document which side in specific the symptoms were present, you submit 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. 

What’s different: After October 1, 2015, you will need to report the sciatica code based on the side that it is occurring. You do have a code for unspecified, but you should always code to the highest specificity. “The ICD-10 change is going to be more accurate with the diagnosis process,” Blackmon says.

Documentation: Your physician probably already specifies right or left, but now you have new codes to reflect that. “We as coders will have to insist our physicians do a better job of their documentation in order for this process to go smoothly,” Blackmon says. 

This is how you will locate your codes in the Alphabetical Index:

Sciatica

M54.3-

Coding Tips: You will see an Excludes1 note under the M54.3 (Sciatica) category stating you should not report these codes with lesion of sciatic nerve (G57.0), sciatica due to intervertebral disc disorder (M51.1-), or sciatica with lumbago (M54.4-).