Pain Management Coding Alert

Published on Tue Dec 23, 2014 PDF

You’ll shift from 1 to 6 code choices. 

Sciatica is pain caused by compression of a spinal nerve root in the lower back, often due to degeneration of an intervertebral disc. The pain affects the back, hip, and outer side of the leg and can range from feeling like a bad leg cramp to being so excruciating that the patient can barely sit or stand. 

When your physician diagnoses sciatica, you currently have a single ICD-9 code to report: 724.3 (Sciatica). Coding notes explain that 724.3 applies to neuralgia or neuritis of the sciatic nerve, but does not include conditions such as collapsed vertebra, intervertebral disc disorders, or spondylosis. 

ICD-10 change: Shifting to ICD-10 in October 2015 will expand your options for assigning a diagnosis for sciatica. The codes will specify the affected side as well as include whether the condition exists in conjunction with lumbago (low back pain).  

Diagnoses from ICD-10 will include: 

• M54.30 – Sciatica, unspecified side 
  
• M54.31 – Sciatica, right side 
  
• M54.32 – Sciatica, left side 
  
• M54.40 – Lumbago with sciatica, unspecified side 
  
• M54.41 – Lumbago with sciatica, right side 
  
• M54.42 – Lumbago with sciatica, left side. 
  

Coding tips: You always want to encourage your providers to document a patient’s condition as thoroughly as possible so you can select the most appropriate diagnosis. This mindset is especially important for sciatica and other diagnoses that will depend on laterality under ICD-10. Any details your provider notes regarding the affected side and whether other symptoms also are present (such as lumbago) will help you code more accurately. Including a note of “laterality” beside the sciatica diagnosis on your superbill might help providers remember to document that detail. 

Did you know? The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. The pain of sciatica is sometimes referred to as sciatic nerve pain.