ICD Code M54.31

ICD code M5431 is used to identify and classify the medical condition known as sciatica on the right side of the body. Sciatica refers to pain that radiates along the path of the sciatic nerve, which extends from the lower back through the hips and buttocks and down each leg. When this code is used, it specifically indicates that the sciatica symptoms are affecting the right side, which can include pain, tingling, numbness, or weakness in the right leg. This code is crucial for healthcare providers to accurately document the condition for treatment planning, billing, and insurance purposes.

When to use the ICD code for sciatica, right side:

1. Presence of Pain: Patient reports unilateral pain radiating from the lower back down the right leg.

2. Nerve Root Involvement: Symptoms suggest involvement of the right sciatic nerve, typically characterized by sharp, shooting pain.

3. Sensory Changes: Patient experiences numbness, tingling, or a burning sensation in the right leg or foot.

4. Motor Weakness: There may be observable weakness in the right leg, affecting the ability to move or control the leg.

5. Aggravating Factors: Symptoms worsen with prolonged sitting, standing, or certain movements, such as bending or twisting.

6. Relieving Factors: Pain relief is noted when changing positions, lying down, or using heat or ice therapy.

7. Duration of Symptoms: Symptoms have persisted for a specific duration, typically more than a few days, indicating a chronic condition.

8. Exclusion of Other Conditions: Other potential causes of leg pain, such as fractures, tumors, or vascular issues, have been ruled out through appropriate diagnostic imaging or examinations.

For the ICD code M54.31, which pertains to sciatica on the right side, the relevant CPT codes that may be used for treatment include:

1. CPT 20552 - Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

2. CPT 20553 - Injection(s); single or multiple trigger point(s), 3 or more muscles.

3. CPT 20610 - Arthrocentesis, aspiration and/or injection into a major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.

4. CPT 64483 - Injection(s), anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level.

5. CPT 64484 - Injection(s), anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, each additional level (List separately in addition to code for primary procedure).

6. CPT 97032 - Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes.

7. CPT 97110 - Therapeutic exercises to develop strength and endurance, range of motion and flexibility, each 15 minutes.

8. CPT 97140 - Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes.

These CPT codes are commonly associated with the treatment of conditions related to the ICD code M54.31. It is important for healthcare providers to select the appropriate CPT code based on the specific treatment administered and the clinical scenario. Always ensure that documentation supports the services billed and that coding is compliant with payer policies.

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