Finding the Right ICD-10 Code For Sciatica

According to the Cleveland Clinic, 40% of Americans will experience sciatica at some point in their life—which means as a rehab therapist, you need to be prepared for when those patients come through your doors. We’re breaking down a little bit about this common condition, including the ICD-10 code for sciatica, in this compact guide. 

What is sciatica?

Sciatica (also referred to as lumbar radiculopathy) is a condition characterized as an injury to your sciatic nerve, which is the bundle of nerves that runs down each of your legs. The sciatic nerve begins at your hip and runs through your leg to below your knee. If that nerve is irritated, it can produce several symptoms, including:

• Lower back pain radiating to your buttock or back of thigh;
• Pain that spreads from the buttock to your foot;
• Paresthesia, often referred to as tingling or “pins and needles”; and
• Numbness and muscle weakness, in severe cases

In some instances, the condition may also be referred to as lumbago with sciatica, with lumbago being an older term used for generalized low back pain.  

What are some of the causes of sciatica?

Given how common sciatica is among the general population, it’s no surprise that there are plenty of root causes for the condition. Common contributors or causes of sciatica seen in rehab therapy practices can include:

• Muscular imbalances;
• Obesity;
• Poor posture;
• Awkward sitting positions; or
• Any nerve disorders.

Additionally, Johns Hopkins Medicine notes that some of the following might indicate a diagnosis of sciatica and necessitate a physician referral:

• A tumor;
• An abscess;
• A blood clot;

The Cleveland Clinic also identifies several medical conditions that could result in sciatica, like:

• Herniated discs
• Degenerative disc disease
• Spinal stenosis
• Foraminal stenosis
• Spondylolisthesis
• Osteoarthritis
• Injuries
• Pregnancy
• Conus medullaris syndrome
• Cauda equina syndrome

What are the complications caused by sciatica?

In an article for the National Library of Medicine, David Davis, Kushagra Maini; Muhammad Taqi, and Arvind Vasudevan identify the potential medical complications that can arise from sciatica:  

• Increased pain over time;
• Paresthesias in the affected leg;
• Loss of muscular strength in the affected leg;
• Loss of bowel or bladder function; and
• Permanent nerve damage.

What are some of the risk factors for sciatica?

Some medical risk factors may put people more at risk of developing the condition, according to the Mayo Clinic:

• Your age. A herniated disc is the most likely cause of sciatica, and people between the ages of 20 and 50 are most likely to suffer from a herniated disc.  
• Obesity or excess weight. Added weight can put added strain on your spine and back muscles.
• Your profession. Jobs that require sitting, bending, and twisting increase your chances of developing sciatica—particularly if you’re using poor form when bending and lifting. Similarly, jobs that require prolonged sitting can lead to sciatica, especially if you’re sitting with insufficient back support.  
• Diabetes. Type 2 diabetes increases the risk of peripheral neuropathy, which could damage your sciatic nerve (among others). 

What is the ICD-10 code for sciatica?

So, which diagnosis code would you use for a patient with sciatica? As you might imagine, there is more than one ICD-10 code for sciatica. Here are the different ICD-10 codes based on the degree of specificity you can identify.

• M54.3 Sciatica
• M54.30 Sciatica, unspecified side
• M54.31 Sciatica, right side
• M54.32 Sciatica, left side 

Code M54.3 should not be used if another, more specific code is applicable. 

What are the type 1 excludes for sciatica?

For the ICD-10 code for sciatica listed above, only M54.3 has Excludes1 edits: 

• Lesion of sciatic nerve (G57.0)
• Sciatica due to intervertebral disc disorder (M51.1-)
• Sciatica with lumbago (M54.4)

How can patients prevent sciatica?

Obviously, physical therapy is the best course of action for patients suffering from sciatica. That said, most people (and most PTs) would rather avoid instances of sciatica in the first place. Here are some tips on how the average rehab therapist can help patients avoid leg and back pain in the first place, courtesy of Harvard Health.

• Increased exercise. Whether that’s lifting weights, jogging or running, or doing yoga, exercise will help keep sciatica at bay.
• Build up your core. Strengthening the muscles in the back, hips, pelvis, and buttocks can also help your body better support the spine.
• Stand up regularly. With many of us consigned to a desk all day, it’s essential to take regular breaks to stand up and stretch your legs.
• Keep your weight in check. As mentioned above, extra weight puts extra pressure on your spine, so losing even a few pounds can help avoid sciatica. 
• Stop slouching. Poor posture can lead to back problems, so try to make a habit of sitting up straight. 

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Hopefully, we’ve provided you with an in-depth look at the basics of sciatica, including the ICD-10 code for sciatica and how you can help patients prevent a reoccurrence in the future. After all, while providers are always ready to provide medical care, they’d much rather patients not have to deal with pain radiating throughout their back and legs.