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v1.0.0
ICD-10 Guide
ICD-10 CodesM54.4

M54.4

Billable

Lumbago with sciatica

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M54.4 is a billable code used to indicate a diagnosis of lumbago with sciatica.

Key Diagnostic Point:

Lumbago with sciatica refers to lower back pain (lumbago) that is accompanied by pain radiating down the leg, typically following the path of the sciatic nerve. This condition often arises from lumbar disc herniation, spinal stenosis, or degenerative disc disease, leading to nerve root compression. Patients may experience symptoms such as sharp or burning pain, numbness, and weakness in the affected leg. The pain can be exacerbated by prolonged sitting, standing, or certain movements. Diagnosis is primarily clinical, supported by imaging studies like MRI or CT scans to identify underlying causes. Treatment options vary and may include conservative management such as physical therapy, medications (NSAIDs, muscle relaxants), and lifestyle modifications. In cases where conservative measures fail, surgical interventions like discectomy or laminectomy may be considered to relieve nerve compression. The prognosis is generally favorable with appropriate treatment, but chronic cases can lead to persistent pain and disability.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between lumbago and other back pain diagnoses
  • Identifying the specific cause of sciatica
  • Documenting the severity and duration of symptoms
  • Understanding the relationship between lumbago and sciatica

Audit Risk Factors

  • Inadequate documentation of symptoms and their impact on daily activities
  • Failure to specify the duration of symptoms
  • Lack of imaging or diagnostic support for the diagnosis
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of present illness, physical examination findings, imaging results, and treatment plan.

Common Clinical Scenarios

Patients presenting with acute or chronic low back pain with radicular symptoms.

Billing Considerations

Ensure documentation reflects the severity and functional limitations caused by the condition.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional status, pain levels, and response to therapy.

Common Clinical Scenarios

Patients undergoing rehabilitation for sciatica-related pain.

Billing Considerations

Focus on documenting progress and functional improvements over time.

Coding Guidelines

Inclusion Criteria

Use M54.4 When
  • Follow official ICD
  • CM guidelines for coding lumbago with sciatica, ensuring accurate documentation of symptoms, duration, and any relevant imaging findings
  • Include any co
  • existing conditions that may affect treatment

Exclusion Criteria

Do NOT use M54.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

63030CPT Code

Laminectomy, facetectomy, and/or foraminotomy

Clinical Scenario

Used in surgical treatment of lumbar spinal stenosis causing sciatica.

Documentation Requirements

Document the indication for surgery, pre-operative assessments, and post-operative care.

Specialty Considerations

Orthopedic surgeons should ensure detailed operative notes are provided.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like lumbago with sciatica, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like lumbago with sciatica, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 is the difference between M54.4 and M54.5?

M54.4 specifically includes sciatica as a symptom of lumbago, while M54.5 refers to low back pain without sciatica.