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2025 ICD-10-CM code M54.3

Sciatica

Code M54.3 should not be used if the sciatica is due to an intervertebral disc disorder (M51.1-) or if it is associated with lumbago (M54.4-). If the cause of sciatica is known, an additional code should be assigned to specify the underlying condition. Do not code lesion of the sciatic nerve (G57.0) with M54.3.

Medical necessity for treatment of sciatica is established by the presence of symptoms that significantly impact the patient's function and quality of life.Treatment is aimed at alleviating pain, improving mobility, and addressing the underlying cause of the nerve compression.

Providers diagnose sciatica based on physical examination, including assessment of reflexes, sensation, and muscle strength. Imaging studies like X-rays, CT scans, and MRIs may be used to identify the underlying cause, such as a herniated disc or spinal stenosis. Electromyography and nerve conduction studies can help assess nerve damage.

In simple words: Sciatica is a pain that runs down one leg from the lower back. It happens when the sciatic nerve, the longest nerve in your body, is irritated or pressed on. This can be caused by things like a slipped disk, arthritis, or even a muscle spasm. The pain can range from a mild ache to a sharp, burning sensation, and you might also have numbness or tingling in your leg, foot, or toes.

Sciatica refers to pain, numbness, or tingling that radiates along the sciatic nerve, which runs from your lower back through your hips and buttocks and down each leg.It typically affects only one side of your body.

Example 1: A 45-year-old male presents with lower back pain radiating down his right leg, along with numbness and tingling in his toes.An MRI reveals a herniated disc pressing on the sciatic nerve., A pregnant woman experiences sharp pain in her buttock and down the back of her thigh, worsening with prolonged sitting. This is attributed to pressure on the sciatic nerve from the growing fetus., A 60-year-old female reports chronic lower back pain and stiffness accompanied by occasional shooting pain down her left leg.Diagnosis reveals lumbar spinal stenosis causing sciatic nerve compression.

Documentation should include the location, quality, and radiation of the pain, as well as any associated symptoms like numbness, tingling, or weakness.The provider should document the physical exam findings, including neurological assessment, and results of any imaging or diagnostic tests. The underlying cause of the sciatica, if determined, should also be documented.

** Sciatica is often self-limiting and resolves with conservative treatment, including rest, ice/heat therapy, over-the-counter pain relievers, and gentle stretching.More severe or persistent cases may require physical therapy, prescription medications, injections, or in rare instances, surgery.

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