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M54.30
ICD-10-CM
Sciatica Pain

Find information on sciatica pain diagnosis, including clinical documentation, medical coding (ICD-10-CM M54.1, M54.10, M54.11, M54.12), radiculopathy, lumbar radiculopathy, nerve root compression, and lower back pain symptoms. Learn about healthcare provider resources for accurate sciatica diagnosis and treatment options. This resource offers guidance for proper medical coding and documentation related to sciatica for healthcare professionals.

Also known as

Sciatic Nerve Pain
Radicular Pain
Lumbosacral Radiculopathy

Diagnosis Snapshot

Key Facts
  • Definition : Pain radiating along the sciatic nerve, often from lower back to leg.
  • Clinical Signs : Lower back pain, leg numbness or weakness, pain worsening with movement.
  • Common Settings : Primary care, orthopedics, physiotherapy, pain management clinics.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M54.30 Coding
M54.3-M54.4

Sciatica

Pain radiating along the sciatic nerve.

M51.1

Lumbago with sciatica

Lower back pain combined with sciatic nerve pain.

G55.0-G55.9

Nerve root and plexus compressions

Compressed nerves, which can cause sciatica-like symptoms.

M79.2

Neuralgia and neuritis, unspecified

General nerve pain that may include sciatica if not specified further.

Code-Specific Guidance

Decision Tree for

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

Is the sciatica due to a herniated disc?

  • Yes

    Confirmed by imaging?

  • No

    Is there lumbar spinal stenosis?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Sciatica pain radiating down the leg
Lumbar spinal stenosis
Piriformis syndrome

Documentation Best Practices

Documentation Checklist
  • Sciatica pain diagnosis documentation: ICD-10 code, laterality
  • Symptom onset, duration, character, and exacerbating factors
  • Physical exam: Straight leg raise, sensory/motor deficits
  • Imaging results (MRI, CT) correlating with sciatica
  • Prior treatments, response, current medications

Coding and Audit Risks

Common Risks
  • Code Specificity

    Lack of laterality (right/left) or specific radiating site documentation can lead to unspecified sciatica coding (M54.3) impacting reimbursement.

  • Underlying Cause

    Failure to document the underlying cause of sciatica (e.g., herniated disc) can lead to inaccurate coding and underreporting severity for quality metrics.

  • Documentation Clarity

    Vague documentation like low back pain with radiation down leg may be insufficient to justify a specific sciatica diagnosis and code (M54.4).

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding (M54.3-M54.4) for sciatica improves CDI
  • Document radiating pain, numbness, muscle weakness for proper HCC coding
  • Comply with payer guidelines for nerve conduction studies, MRIs
  • Regularly review clinical documentation for sciatica to improve coding accuracy
  • Standardized pain assessment tools enhance CDI, ensure compliance

Clinical Decision Support

Checklist
  • Verify unilateral leg pain below the knee
  • Confirm pain radiating along dermatome
  • Positive straight leg raise test noted
  • Neurological deficits present in leg
  • Exclude alternative diagnoses lower back pain

Reimbursement and Quality Metrics

Impact Summary
  • Sciatica Pain: Coding accuracy impacts reimbursement for M54.3, M54.4, and other related codes. Proper documentation crucial for optimal claims processing.
  • Hospital reporting of sciatica pain diagnoses affects quality metrics related to pain management effectiveness and patient satisfaction scores.
  • Accurate coding (ICD-10 M54.3, M54.4) ensures appropriate DRG assignment impacting hospital reimbursement under prospective payment systems.
  • Medical billing errors for sciatica can lead to claim denials, reduced revenue, and increased administrative burden. Coding reviews essential.

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 M54.1 for sciatica
  • Document radiation, laterality
  • Specify if lumbar or sacral
  • Link to underlying cause code
  • Note pain severity if documented

Documentation Templates

Patient presents with complaints consistent with sciatica pain.  Symptoms include lower back pain radiating down the leg, described as sharp, burning, or shooting.  The patient reports pain radiating to the buttock, thigh, and posterior calf, occasionally extending to the foot.  Onset of sciatica symptoms is reported as gradual, potentially exacerbated by prolonged sitting, bending, or lifting.  Physical examination reveals tenderness to palpation along the sciatic nerve distribution.  Positive straight leg raise test elicits radicular pain.  Neurological examination demonstrates possible sensory deficits, including numbness, tingling, or weakness in the affected leg.  Differential diagnosis includes lumbar disc herniation, spinal stenosis, piriformis syndrome, and degenerative disc disease.  Assessment suggests sciatica, likely secondary to lumbar radiculopathy.  Plan includes conservative management with NSAIDs for pain relief, physical therapy for core strengthening and flexibility exercises, and patient education on proper body mechanics.  Referral to pain management or spine specialist will be considered if symptoms persist or worsen.  Follow-up scheduled in two weeks to assess response to treatment.  ICD-10 code M54.3, low back pain with sciatica, is assigned.  CPT codes for evaluation and management, physical therapy, and potential imaging studies will be documented based on services provided.