ICD Code M54.40

ICD code M5440 is used to classify a medical condition known as "Lumbago with sciatica, unspecified side." This code is part of the International Classification of Diseases (ICD) system, which is used by healthcare providers to standardize the diagnosis of diseases and health conditions. Specifically, M5440 refers to a situation where a patient is experiencing lower back pain (lumbago) that is accompanied by sciatica, a condition characterized by pain radiating along the sciatic nerve, which runs down one or both legs from the lower back. The term "unspecified side" indicates that the documentation does not specify whether the sciatica is affecting the left side, right side, or both sides of the body. This code is crucial for accurate medical billing and helps ensure that healthcare providers are reimbursed appropriately for the care they provide.

When considering the use of the ICD code M5440, the following diagnostic criteria and symptoms should be evaluated:

1. Presence of Lumbago: The patient must exhibit lower back pain, commonly referred to as lumbago.

2. Radiating Pain: The patient should report pain that radiates down the leg, indicating potential involvement of the sciatic nerve.

3. Unspecified Side: The symptoms should not be localized to a specific side of the body; the pain may be bilateral or not clearly defined as left or right.

4. Duration of Symptoms: The patient should have experienced symptoms for a duration that suggests a chronic or recurrent condition, rather than acute or transient pain.

5. Exclusion of Other Conditions: Other potential causes of lower back pain and sciatica should be ruled out, including herniated discs, spinal stenosis, or other specific diagnoses that would require different coding.

6. Functional Impact: The symptoms should be significant enough to impact the patient's daily activities or quality of life, warranting medical evaluation and treatment.

7. Clinical Evaluation: A thorough clinical assessment should be conducted, including physical examination and possibly imaging studies, to support the diagnosis of lumbago with sciatica.

By adhering to these criteria, healthcare providers can ensure appropriate use of the ICD code M5440 in their documentation and billing processes.

For the ICD code M54.40 (Lumbago with sciatica, unspecified side), the relevant CPT codes that may be applicable for treatment include:

1. 99201-99205 - New patient office or other outpatient visit.

2. 99211-99215 - Established patient office or other outpatient visit.

3. 20552 - Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

4. 20553 - Injection(s); single or multiple trigger point(s), 3 or more muscles.

5. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa.

6. 97110 - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility.

7. 97140 - Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

8. 97032 - Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes.

9. 97035 - Application of a modality to one or more areas; ultrasound, each 15 minutes.

10. G0283 - Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care.

These CPT codes are commonly used in the treatment and management of conditions associated with lumbago and sciatica. It is important for healthcare providers to select the appropriate CPT code based on the specific services rendered and the clinical scenario.

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments for CPT codes associated with ICD code M5440. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.