ICD-10 Coding for Pain in Buttocks(M54.31, G57.01)
Complete ICD-10-CM coding and documentation guide for Pain in Buttocks. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pain in Buttocks
M54.30-M54.32Primary Range
Sciatica
This range covers sciatica, a common cause of buttock pain due to nerve compression.
Piriformis Syndrome
This range includes piriformis syndrome, which can cause buttock pain due to muscle spasm and nerve compression.
Chronic Pain
This code is used for chronic pain management, often secondary to site-specific codes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.31 | Sciatica, right side | Use when sciatica is the primary focus with right-sided symptoms. |
|
| G57.01 | Piriformis Syndrome, right side | Use when piriformis syndrome is confirmed with right-sided symptoms. |
|
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 pain in buttocks
Essential facts and insights about Pain in Buttocks
Primary ICD-10-CM Codes for pain in buttocks
Decision Criteria
clinical Criteria
- Presence of radiating pain and positive SLR
documentation Criteria
- Detailed description of pain characteristics and imaging findings
Applicable To
- Right-sided sciatica
Excludes
- Low back pain (M54.5)
Clinical Validation Requirements
- Radiating pain past knee
- Positive straight leg raise (SLR)
- Imaging showing nerve compression
Code-Specific Risks
- Misclassification if laterality is not specified.
Coding Notes
- Ensure documentation supports nerve involvement and laterality.
G57.01 - Piriformis Syndrome, right side
Use when piriformis syndrome is confirmed with right-sided symptoms.
Applicable To
- Right-sided piriformis syndrome
Excludes
- Sciatica (M54.3-)
Clinical Validation Requirements
- Tenderness over piriformis muscle
- Positive Pace sign
- FAIR test
Coding Notes
Document muscle spasm and nerve compression clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic Pain
G89.29Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pain in Buttocks to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.31.
Impact
Clinical: Leads to incorrect diagnosis coding., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document side of pain., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M54.3- for radiating pain with nerve involvement.
Impact
Using M54.5 for radiating pain can trigger audits.
Mitigation Strategy
Ensure documentation supports the use of M54.3- for radiating pain.
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 Pain in Buttocks, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pain in Buttocks
Use these documentation templates to ensure complete and accurate documentation for Pain in Buttocks. These templates include all required elements for proper coding and billing.
Chronic Sciatica
Specialty: OrthopedicsRequired Elements
- Pain characteristics
- Radiation pattern
- Physical exam findings
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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