Use Combo Codes to Reduce Dx Coding Burden
Question: An established patient reports to the practice with a diagnosis of right-sided sciatica and lumbago. The surgeon spends 22 minutes providing evaluation and management (E/M) services to the patient. What pair of diagnosis codes should I report for this encounter? I was thinking M54.31 and M54.50. Iowa Subscriber Answer: You should not report M54.31 (Sciatica, right side) and M54.50 (Low back pain, unspecified) — or any other code pair — to represent this patient’s condition. Why? There’s a single combination ICD-10-CM code that can relay the patient’s diagnosis more clearly and effectively. On your claim, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.) for the E/M service with M54.41 (Lumbago with sciatica, right side) appended to represent the patient’s back pain and sciatica. Chris Boucher, MS, CPC, Senior Development Editor, AAPC
