ICD-10 Coding for Lumbago with Sciatica(M54.41, M54.42, M54.40)
Complete ICD-10-CM coding and documentation guide for Lumbago with Sciatica. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lumbago with Sciatica
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.41 | Lumbago with sciatica, right side | Use when sciatica is present with lumbago on the right side without a confirmed disc disorder. |
|
| M54.42 | Lumbago with sciatica, left side | Use when sciatica is present with lumbago on the left side without a confirmed disc disorder. |
|
| M54.40 | Lumbago with sciatica, unspecified side | Use when sciatica is present with lumbago but laterality is not documented. |
|
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 lumbago with sciatica
Essential facts and insights about Lumbago with Sciatica
Primary ICD-10-CM Codes for lumbago with sciatica
Decision Criteria
clinical Criteria
- Presence of right-sided low back pain with leg radiation
Applicable To
- Low back pain with right-sided sciatica
Excludes
- Sciatica due to disc disorder (M51.1-)
Clinical Validation Requirements
- Right-sided low back pain with radiation to the leg
- Positive straight leg raise test on the right
Code-Specific Risks
- Risk of under-documenting laterality
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
M54.42 - Lumbago with sciatica, left side
Use when sciatica is present with lumbago on the left side without a confirmed disc disorder.
Applicable To
- Low back pain with left-sided sciatica
Excludes
- Sciatica due to disc disorder (M51.1-)
Clinical Validation Requirements
- Left-sided low back pain with radiation to the leg
- Positive straight leg raise test on the left
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
M54.40 - Lumbago with sciatica, unspecified side
Use when sciatica is present with lumbago but laterality is not documented.
Applicable To
- Low back pain with sciatica, unspecified side
Excludes
- Sciatica due to disc disorder (M51.1-)
Clinical Validation Requirements
- Low back pain with leg radiation, side not specified
Coding Notes
Encourage documentation of laterality to avoid unspecified coding.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Intervertebral disc disorders with radiculopathy, lumbar region
M51.16Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lumbago with Sciatica to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.41.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Train staff on importance of laterality documentation., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation of patient conditions.
Mitigation Strategy
Use M51.1- codes when disc pathology is confirmed by imaging.
Impact
Coding without specifying laterality can lead to audits.
Mitigation Strategy
Ensure documentation includes laterality.
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 Lumbago with Sciatica, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lumbago with Sciatica
Use these documentation templates to ensure complete and accurate documentation for Lumbago with Sciatica. These templates include all required elements for proper coding and billing.
Lumbago with left-sided sciatica
Specialty: OrthopedicsRequired Elements
- Patient history of low back pain
- Radiation to left leg
- Positive straight leg raise test
- Neurological exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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