Sciatica is a chronic pain condition caused by compression or irritation of the sciatic nerve, usually from a herniated disc or bone spur on the spine. It affects one side of the body and causes symptoms like low back pain radiating into the buttocks and leg. Diagnosis involves examining the patient's medical history and testing imaged like MRI to identify the pain source. Treatment may include self-care, medications, physical therapy, injections, or surgery to remove the compressed area pressing on the nerve. Proper clinical documentation and use of ICD-10 codes like M54.3 and M51.16 are needed for medical billing and coding of sciatica cases.

1. Diagnosing,
Documenting and
Coding Sciatica
Sciatica is usually caused by a compressed nerve in the
lower spine. The blog discusses the causes, symptoms,
treatment options, and ICD-10 codes for sciatica.
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If you have low back pain that radiates through the buttocks down to one
leg, it may be a sign of sciatica. Sciatica is a chronic pain condition that
occurs due to the compression or irritation of sciatic nerve. Regarded as one
of the most common causes of low back and leg pain, sciatica typically
affects people in the 30-50 year age group. According to a
MedicalNewsToday report, up to 40 percent of people will experience sciatica
at least once in their life time, making it challenging to manage. Physician
practices treating patients with sciatica need to know the ICD-10 codes to
report diagnoses correctly. Outsourcing medical billing services can
ensure complete, accurate and timely claim filing for appropriate
reimbursement.
Causes and Symptoms
Sciatica usually affects only one side of the body. The pain may start as a
mild ache to a sharp, burning sensation or excruciating pain. It can get
worse when you sit, cough or sneeze.. The potential risk factors associated
with the condition include - age, obesity, prolonged sitting and diabetes.
Although the pain associated with sciatica can be severe, most cases resolve
with a combination of non-surgical treatment modalities. However, people
who experience severe symptoms like leg weakness or bowel or bladder
changes may need to undergo surgery for the same.
The nerve condition occurs when the sciatic nerve becomes compressed or
irritated usually by a herniated disk in the spine or overgrowth of bone (bone
spur) on the vertebrae. Other factors that can cause this condition include -
piriformis syndrome, trauma, osteoarthritis, stenosis, and spondylolisthesis.
In very rare cases, the nerve can be compressed by a tumor or damaged by
diabetes.

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Shooting pain that flows from the lower back through the buttock area and
into the lower limbs is one of the characteristic symptoms of this condition.
Other symptoms include -
 Weakness, numbness, or difficulty moving the leg or foot
 Numbness in the leg along the nerve
 Debilitating hip pain
 Cramping and weakness in the muscles of the involved leg
 Burning or tingling sensation (pins and needles) in the feet and toes
 A shooting pain that makes it difficult to stand up
 A constant pain on one side of the rear
Sciatic Nerve Disorder -- Diagnosis and Treatment
Diagnosis of this nerve condition involves a complete evaluation of patient
medical history and a detailed physical and neurological exam to check
muscle strength and reflexes. As pain usually becomes worse during
activities, the physician may ask the patient to walk on the toes or heels,
rise from a squatting position and, while lying on the back, lift their legs one
at a time. Imaging tests such as X-ray, MRI scan, CT scan or
Electromyography (EMG) may be done to identify the exact source of pain.
Treatment of chronic sciatica usually involves a combination of self-care
measures and medical treatment. Generally, most cases of acute sciatica
respond well to self-care measures like over-the-counter painkillers (such as
ibuprofen, naproxen, or oral steroids), Hot or cold compression packs and
gentle exercises (such as walking or light stretching).
However, if the pain doesn't improve with self-care measures, neurologists
will suggest treatments such as medications (anti-inflammatories, Tricyclic
antidepressants, muscle relaxants and anti-seizure medications), physical
therapy exercises, steroid injections, spinal decompression therapy and

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chiropractic treatment. Surgery may be recommended when the compressed
nerve causes significant weakness, loss of bowel or bladder control, or when
the patient experiences pain that progressively worsens or doesn't improve
with standard therapies. As part of the surgery, the bone spur or the portion
of the herniated disk (that is pressing on the pinched nerve) is removed.
Though sciatica is a chronic nerve disorder, timely appropriate treatment
and proper rest can improve pain within about six weeks. However, if left
untreated, this nerve disorder can lead to serious complications like partial
immobility of the leg, loss of feeling sensation in the leg, and other
functional disabilities such as limitations in walking, sitting and standing.
Activities like frequent twisting, bending and heavy weight lifting that put
additional strain and pressure on back area, being overweight and leading a
sedentary lifestyle can increase the risks of developing this nerve condition.
Maintaining proper posture, exercising regularly, and reducing the hours of
sitting can help prevent future sciatica flare-ups.
Clinical Documentation and ICD-10 Coding
Neurology medical billing and coding involves using the specific ICD-10
diagnosis codes for reporting sciatica on medical claims. Physicians should
document the following:
 Presence of lower back pain - lumbago, sciatica, or both
- If sciatica is present, indicate: left side or right side
- Any type of radiculopathy: indicate if it is associated with an
intervertebral disc disorder (i..e., lumbago with sciatica due to
intervertebral disc
disorder)
 All back pain and radiculopathy: indicate distribution by spine region -
occipto-atlanto-axial, cervical, cervicothoracic, thoracic,

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thoracolumbar, lumbar, lumbosacral, sacral, sacrococcygeal, or
multiple sites in spine
 Specify if sciatica is due to: Lesion of the sciatic nerve, or if lumbago is
due to low back strain
 If the condition is related, include details about the accident (location,
activity, etc.)
 Indicate any psychogenic dorsalgia
ICD-10 codes for Sciatica
 M54.3 - Sciatica
 M54.30 - Sciatica, unspecified side
 M54.31 - Sciatica, right side
 M54.32 - Sciatica, left side
 M54.41 Lumbago with sciatica, right side
 M54.42 Lumbago with sciatica, left side
 M54.5 Low back pain
 M51.16 Intervertebral disc disorders w radiculopathy, lumbar region
 M51.17 ntervertebral disc disorders w radiculopathy, lumbosacral
region
Medical billing and coding for sciatica can be challenging. Outsourcing these
tasks to an established medical billing and coding company that offers
the services of AAPC-certified coding specialists, can help neurology
practices ensure correct and timely medical billing and claims submission.