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v1.0.0
ICD-10 Guide
ICD-10 CodesG54.4

G54.4

Billable

Lumbosacral root disorders, not elsewhere classified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G54.4 is a billable code used to indicate a diagnosis of lumbosacral root disorders, not elsewhere classified.

Key Diagnostic Point:

Lumbosacral root disorders encompass a variety of conditions affecting the lumbosacral nerve roots, which can lead to pain, weakness, and sensory disturbances in the lower extremities. These disorders may arise from various etiologies, including herniated discs, spinal stenosis, trauma, or inflammatory processes. Patients often present with symptoms such as radicular pain, numbness, and motor deficits, which can significantly impact their quality of life. Diagnosis typically involves a thorough clinical evaluation, including a detailed history and physical examination, followed by imaging studies such as MRI or CT scans to visualize the lumbosacral region. Electromyography (EMG) and nerve conduction studies may also be employed to assess nerve function and identify specific root involvement. Treatment options vary based on the underlying cause and may include conservative management with physical therapy, medications, or surgical interventions. Accurate coding of lumbosacral root disorders is essential for appropriate reimbursement and to ensure that patients receive the necessary care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to similar symptoms
  • Need for precise documentation of neurological deficits
  • Differentiation from other lumbosacral disorders
  • Potential for co-morbid conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Failure to specify the affected nerve root(s)
  • Misuse of related codes leading to upcoding or downcoding
  • Inconsistent use of diagnostic imaging results

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, including sensory and motor assessments.

Common Clinical Scenarios

Patients presenting with radicular pain, weakness in lower extremities, or sensory changes.

Billing Considerations

Ensure clear documentation of the neurological deficits and correlation with imaging findings.

Orthopedics

Documentation Requirements

Surgical notes, imaging results, and pre- and post-operative assessments.

Common Clinical Scenarios

Patients undergoing surgical intervention for herniated discs or spinal stenosis.

Billing Considerations

Document the specific surgical procedure and any complications that may arise.

Coding Guidelines

Inclusion Criteria

Use G54.4 When
  • According to ICD
  • 10 guidelines, G54
  • 4 should be used when the lumbosacral root disorder does not fit into more specific categories
  • Coders must ensure that the documentation supports the diagnosis and that all relevant clinical information is included

Exclusion Criteria

Do NOT use G54.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95860CPT Code

Electromyography, needle

Clinical Scenario

Used to assess nerve function in patients with suspected lumbosacral root disorders.

Documentation Requirements

Document the specific muscles tested and the findings.

Specialty Considerations

Neurologists should ensure correlation with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of lumbosacral root disorders, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lumbosacral root disorders, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of lumbosacral root disorders, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common symptoms associated with G54.4?

Common symptoms include lower back pain, radiating pain in the legs, numbness, tingling, and weakness in the lower extremities.

How is G54.4 diagnosed?

Diagnosis typically involves a combination of clinical evaluation, imaging studies such as MRI or CT scans, and nerve conduction studies to assess nerve function.

What treatment options are available for patients with G54.4?

Treatment options may include physical therapy, medications for pain management, and surgical interventions depending on the underlying cause.