ICD-10 Coding for Sciatica(M54.3, M51.1, G57.0)
Complete ICD-10-CM coding and documentation guide for Sciatica. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sciatica
M54.3-M54.4Primary Range
Dorsalgia and sciatica
This range includes codes for sciatica and related conditions such as lumbago with sciatica.
Intervertebral disc disorders with radiculopathy
This range is used when sciatica is due to disc disorders.
Lesion of sciatic nerve
This range is used for sciatic nerve lesions not related to spinal disorders.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.3 | Sciatica | Use when sciatica is idiopathic and not related to disc disorders. |
|
| M51.1 | Intervertebral disc disorders with radiculopathy | Use when sciatica is due to a confirmed disc disorder. |
|
| G57.0 | Lesion of sciatic nerve | Use for sciatic nerve lesions not related to spinal conditions. |
|
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 sciatica
Essential facts and insights about Sciatica
Primary ICD-10-CM Codes for sciatic
Decision Criteria
clinical Criteria
- Pain radiating along the sciatic nerve without disc involvement
Applicable To
- Pain radiating along the sciatic nerve
Excludes
- Sciatica due to intervertebral disc disorder (M51.1-)
Clinical Validation Requirements
- Pain distribution along the sciatic nerve
- Negative MRI for disc pathology
Code-Specific Risks
- Using this code when a disc disorder is present
Coding Notes
- Ensure laterality is specified if known.
M51.1 - Intervertebral disc disorders with radiculopathy
Use when sciatica is due to a confirmed disc disorder.
Applicable To
- Disc herniation with radiculopathy
Excludes
- Sciatica not due to disc disorder (M54.3)
Clinical Validation Requirements
- MRI showing disc herniation
- Nerve root compression evidence
Coding Notes
Document the specific disc level involved.
G57.0 - Lesion of sciatic nerve
Use for sciatic nerve lesions not related to spinal conditions.
Applicable To
- Sciatic neuropathy
Excludes
- Sciatica due to spinal disorders
Clinical Validation Requirements
- EMG showing sciatic nerve lesion
- No spinal pathology on imaging
Coding Notes
Ensure documentation of nerve lesion is clear.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Lumbago with sciatica
M54.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sciatica to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.3.
Impact
Clinical: Leads to non-specific treatment plans., Regulatory: May result in coding audits., Financial: Potential for claim denials.
Mitigation Strategy
Always document side of pain, Use templates that prompt for laterality
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M51.1- codes for disc-related sciatica.
Impact
Using M54.3 for disc-related sciatica.
Mitigation Strategy
Educate coders on proper code selection.
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 Sciatica, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sciatica
Use these documentation templates to ensure complete and accurate documentation for Sciatica. These templates include all required elements for proper coding and billing.
Patient with left-sided sciatica due to disc herniation
Specialty: NeurologyRequired Elements
- Laterality
- Disc involvement
- Neurological findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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