Orthopedic Coding Alert

Make sure you know the laterality with ICD-10.

Non-remitting backache is a common complaint for patients presenting for orthopedic treatment, so understanding how to report these diagnoses in ICD-10 will be especially important.

Tip: You will need to be very selective and specific for the right or left side when reporting lumbago and sciatica.

Review the ICD-9 Codes

Presently, ICD-9-CM has codes 724.2 (Lumbago) and 724.3 (Sciatica) for lumbago and sciatica. "There is also 724.5 (Backache unspecified ) for nonspecific backache," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA. Neither of the codes specifies what side the patient's pain is on, so you report the same codes for both right- and left-sided conditions.

Mark These ICD-10 Changes

Interestingly, ICD-10 includes low back pain, sciatica, and a third condition that combines the two conditions.

The three codes are as under:

• M54.5 -- Low back pain
• M54.3- -- Sciatica
• M54.4- -- Lumbago with sciatica

Look for Anatomical Side Specificity

The ICD-10 is specific for the side of involvement in lumbago and sciatica. "In ICD-10, laterality will be important," affirms Jennifer Schmutz, CPC, health information coder at the Neurosurgical Associates, LLC in Salt Lake City, Utah.

"In ICD-10 you have more codes to choose from and the codes describe whether the pain is on the right or left side. Lumbago can be by itself M54.5 or with sciatica which would be M54.41 for right and M54.42 for the left side," elaborates Teresa Thomas, BBA, RHIT, CPC, practice manager II at St. John's Clinic (Neurosurgery) in Springfield, Missouri.

Key: There is a fifth digit option that will help you to report the side of the pain. "The fifth character placeholder is '-' and is used for to allow future expansion of the ICD-10 code," adds Thomas. The 5th digit of "0" is for unspecified side, "1" is for right side and "2" is for left side," specifies Schmutz. In summary, the fifth-digit allocations for M54.3- and M54.4- will be:

• 0 for unspecified side
• 1 for right side
• 2 for left side

Transitioning to ICD-10

Remember to select from all three codes for diagnosis along with appropriate choice of the fifth-digit allocation when needed. And ask your surgeons to be sure to specify right versus left anatomic location and a specific delineation between lumbago, sciatica, or a combination of the two.

Resource: You can further read about these codes in ICD-10's Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue), subsection/block Other Dorsopathies. You may visit http://apps.who.int/classifications/apps/icd/icd10online/.