ICD-10 Coding for Sciatica with Lumbago(M54.41, M54.42)
Complete ICD-10-CM coding and documentation guide for Sciatica with Lumbago. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sciatica with Lumbago
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. |
|
| M54.42 | Lumbago with sciatica, left side | Use when sciatica is present with lumbago on the left side. |
|
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 with lumbago
Essential facts and insights about Sciatica with Lumbago
Primary ICD-10-CM Codes for sciatica with lumbago
Decision Criteria
clinical Criteria
- Presence of sciatica symptoms on the right side
Applicable To
- Right-sided sciatica with low back pain
Excludes
- Sciatica without lumbago (M54.3-)
Clinical Validation Requirements
- Positive straight leg raise test on the right
- Radiating pain from lumbar region to right leg
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is documented clearly.
M54.42 - Lumbago with sciatica, left side
Use when sciatica is present with lumbago on the left side.
Applicable To
- Left-sided sciatica with low back pain
Excludes
- Sciatica without lumbago (M54.3-)
Clinical Validation Requirements
- Positive straight leg raise test on the left
- Radiating pain from lumbar region to left leg
Coding Notes
Ensure laterality is documented clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sciatica with Lumbago to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.41.
Impact
Clinical: Leads to incomplete clinical documentation., Regulatory: May result in audit findings., Financial: Potential for denied claims.
Mitigation Strategy
Use structured templates., Train staff on importance of laterality.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement., Compliance: May result in non-compliance with coding guidelines., Data Quality: Affects accuracy of clinical data.
Mitigation Strategy
Use M54.4- when both lumbago and sciatica are present.
Impact
Failure to document laterality can lead to audit issues.
Mitigation Strategy
Implement mandatory fields in EHR for 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 Sciatica with Lumbago, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sciatica with Lumbago
Use these documentation templates to ensure complete and accurate documentation for Sciatica with Lumbago. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation
Specialty: OrthopedicsRequired Elements
- Pain location and intensity
- Laterality
- Diagnostic tests performed
- Findings from imaging
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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