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M54.30
ICD-10-CM
Sciatic Nerve Pain

Find information on sciatica diagnosis, including clinical documentation and medical coding for sciatic nerve pain. Learn about ICD-10 codes for sciatica, lumbar radiculopathy, and related lower back pain conditions. This resource covers healthcare provider guidelines for documenting sciatica symptoms, physical exam findings, and diagnostic testing, such as MRI and EMG. Explore treatment options and best practices for managing sciatic nerve pain in a clinical setting.

Also known as

Sciatica
Radicular Pain

Diagnosis Snapshot

Key Facts
  • Definition : Pain radiating along the sciatic nerve path (lower back, buttock, leg)
  • Clinical Signs : Lower back pain, buttock pain, leg pain, numbness, tingling, weakness
  • Common Settings : Primary care, orthopedics, neurosurgery, pain management, physical therapy

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M54.30 Coding
M54.3

Sciatica

Pain radiating along the sciatic nerve.

M54.4

Lumbosacral radiculopathy

Nerve root compression in the lower spine.

M79.2

Neuralgia and neuritis, unspecified

Nerve pain not otherwise specified.

G57.0

Other mononeuropathies of lower limb

Damage to a single nerve in the leg, not sciatica.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is sciatic pain due to trauma?

  • Yes

    Current injury?

  • No

    Due to a Lumbosacral radiculopathy?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Sciatic nerve pain
Lumbar spinal stenosis
Piriformis syndrome

Documentation Best Practices

Documentation Checklist
  • Sciatica ICD-10 code (M54.3, etc.)
  • Detailed pain location & radiation
  • Provoking/palliative factors documented
  • Neurological exam findings (reflexes, strength)
  • Prior treatment & response noted

Coding and Audit Risks

Common Risks
  • Laterality Coding

    Missing or incorrect laterality (right, left, bilateral) for sciatic nerve pain impacts reimbursement and data accuracy. ICD-10 requires specificity.

  • Cause Documentation

    Unspecified sciatica (M54.3) lacks detail. Coders must query physicians for underlying cause (e.g., herniated disc) for proper coding and CDI.

  • Excludes1 Conflicts

    Sciatica diagnoses have Excludes1 notes. Coders must ensure no conflicting diagnoses are coded, impacting medical necessity and compliance audits.

Mitigation Tips

Best Practices
  • Document radicular pain, numbness, tingling for accurate ICD-10 coding (M54.1x)
  • Specify laterality (right/left) and sciatica type for precise diagnosis coding
  • Correlate exam findings (e.g., SLR test) with symptoms for improved CDI
  • Query physician for sciatica etiology (e.g., disc herniation) for compliant billing
  • Document pain management strategies and response to treatment for optimal reimbursement

Clinical Decision Support

Checklist
  • Verify unilateral leg pain radiating below knee
  • Confirm positive straight leg raise test
  • Assess for sensory/motor deficits in leg
  • Document pain characteristics and location
  • Evaluate for underlying causes (disc herniation)

Reimbursement and Quality Metrics

Impact Summary
  • Sciatic Nerve Pain: Coding accuracy impacts reimbursement for M54.3, M54.4, other related codes.
  • Proper ICD-10 coding (M54.3x) crucial for sciatica claims. Avoid denials, optimize revenue cycle.
  • Accurate documentation of sciatica symptoms & etiology key for appropriate E/M coding & higher RVU.
  • Patient-reported outcomes data for sciatica pain management impacts hospital quality reporting & value-based care.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code sciatica, not low back pain
  • Laterality matters: Use modifiers
  • Document radiating pain, numbness
  • Include EMG/NCS findings if done
  • Specify cause if known: disc, stenosis

Documentation Templates

Patient presents with complaints consistent with sciatic nerve pain, also known as sciatica.  Symptoms include lower back pain radiating down the leg, described as a burning, tingling, or shooting sensation.  The pain follows the path of the sciatic nerve, extending through the buttock, thigh, and potentially to the foot.  Onset of symptoms was reported as [Onset timeframe - e.g., gradual over several weeks, sudden after lifting heavy object].  Patient reports [Severity - e.g., mild, moderate, severe] pain impacting [Activities of daily living - e.g., walking, sitting, sleeping].  Physical examination reveals [Objective findings - e.g., tenderness to palpation along the sciatic nerve, positive straight leg raise test, decreased reflexes].  Differential diagnosis includes lumbar disc herniation, piriformis syndrome, spinal stenosis, and sacroiliac joint dysfunction.  Assessment suggests sciatica likely due to [Suspected cause - e.g., lumbar disc herniation at L4-L5].  Plan includes [Treatment plan - e.g., conservative management with NSAIDs, physical therapy referral, MRI lumbar spine to confirm diagnosis, consideration for corticosteroid injection if symptoms persist].  Patient education provided on sciatica management, proper body mechanics, and activity modification.  Follow-up scheduled in [Follow-up timeframe - e.g., two weeks] to assess response to treatment.  ICD-10 code: M54.3.  CPT codes for evaluation and management, and any procedures performed, will be documented separately.
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