M50-M54
Other dorsopathies

M54.42

Billabel:
Yes
No

M54.42 - Lumbago with sciatica, left side (ICD-10)

ICD-10 code M54.42 - Lumbago with sciatica, left side. Classified under Other dorsopathies, this condition involves clinical findings relevant to diagnosis and documentation accuracy.

Overview

Lumbago with sciatica left side under ICD-10 code M54.42 represents a musculoskeletal condition that may impact functional mobility pain perception and overall quality of life.

  • Document acuity (acute, subacute, chronic).
  • Include anatomic region/level and laterality.
  • Correlate symptoms with exam and imaging when used.
  • Avoid unspecified codes when details exist in the note.
  • Verify payer policy/LCD before procedures.
  • Ensure medical necessity is explicit.

Comman symptoms

  • Dermatomal pain radiating to limb; numbness or tingling
  • Positive straight leg raise or Spurling sign by region
  • Motor/sensory deficits may map to root level

Red Flag

  • Severe or progressive neurologic deficit
  • Fever unexplained weight loss night sweats
  • History of cancer immunosuppression or IV drug use
  • Trauma with suspected fracture
  • Bowel/bladder dysfunction or saddle anesthesia

At a Glance

  • ICD-10 code: M54.42
  • Condition: Lumbago with sciatica, left side
  • Category: Radiculopathy & Sciatica
  • Related ICD-10 codes: M54.16, M54.30-M54.32, M54.40-M54.42
  • Common CPT links: 99202-99215, 72100-72148 (imaging), 62321/62323 (ESI)
  • Use the most specific laterality/region code your note supports.

Overview

Lumbago with sciatica left side under ICD-10 code M54.42 represents a musculoskeletal condition that may impact functional mobility pain perception and overall quality of life.

  • Document acuity (acute, subacute, chronic).
  • Include anatomic region/level and laterality.
  • Correlate symptoms with exam and imaging when used.
  • Avoid unspecified codes when details exist in the note.
  • Verify payer policy/LCD before procedures.
  • Ensure medical necessity is explicit.

Causes & Risk Factors

Lumbago with sciatica, left side (M54.42) can arise from a combination of biomechanical stress, degenerative processes, systemic inflammation, or trauma. Common risk factors include aging, occupational strain, obesity, and genetic predisposition. Lifestyle factors such as poor posture, repetitive movement, or low physical conditioning also contribute to chronic musculoskeletal pain.

Diagnostic Workup

Accurate coding of Lumbago with sciatica, left side requires clear diagnostic workup. Clinicians often rely on physical examination findings such as range of motion limits, palpation tenderness, or neurovascular testing. Imaging-X-ray, MRI, or ultrasound-may confirm degenerative, inflammatory, or structural changes. Laboratory tests are typically ordered if autoimmune or metabolic causes are suspected.

Treatment & Rehabilitation

While this resource focuses on ICD-10 coding, understanding general management helps coders interpret documentation. Treatment for Lumbago with sciatica, left side may include physical therapy, posture correction, ergonomic modifications, or supervised exercise programs. Pharmacologic therapy and procedural interventions should be captured through appropriate CPT and HCPCS codes when documented. Rehabilitation aims to restore strength, range of motion, and prevent recurrence.

Prevention

Preventing recurrent musculoskeletal issues requires a holistic approach-educating patients on stretching routines, core strengthening, and activity modification. For clinicians, structured documentation templates and s can ensure accurate, defensible coding for audit readiness.

Coding Examples

  • Example 1: Patient with lumbago with sciatica left side and documented left-sided involvement - code M54.42-L.
  • Example 2: Chronic pain after prior injury with imaging-confirmed degeneration - use M54.42 with chronicity modifier where applicable.
  • Example 3: Bilateral presentation with limited range of motion - choose most specific laterality code variants.

Audit & Compliance

Ensure ICD-10 coding aligns with payer policies and medical necessity. Redundant use of unspecified codes is a common audit trigger. For complex cases, link diagnosis codes to procedure CPTs in the superbill and verify that documentation supports frequency and modality of care.

Clinical Example

Chief Complaint: Patient presents with lumbago with sciatica left side over the past several weeks reporting intermittent pain and reduced function.

Subjective: The patient describes symptoms as dull aching and aggravated by movement or prolonged posture. Pain score rated 6/10 relieved partially by rest or heat.

Objective: Physical examination reveals localized tenderness reduced range of motion and no neurological deficit. Imaging reviewed indicates findings consistent with lumbago with sciatica left side (M54.42).

Assessment: Lumbago with sciatica

left side (M54.42) - consistent with radiculopathy & sciatica.

Plan: Continue conservative management monitor progression and re-evaluate in 4-6 weeks. Documentation supports ICD-10 code usage as primary diagnosis.

Differential Diagnoses

When coding lumbago with sciatica, left side, consider alternative or coexisting conditions that may share similar symptoms. Accurate differentiation ensures correct ICD-10 assignment and proper claim justification.

  • Strain
  • Sprain
  • Tendinitis
  • Osteoarthritis
  • Soft-tissue injury

Documentation Best Practices

  • Document acuity (acute subacute chronic) and laterality when available.
  • Capture specific region/level (e.g. cervical vs lumbar; right vs left; primary vs secondary OA).
  • Link symptoms to exam and imaging findings when relevant; avoid unsupported specificity.
  • Use the most specific code supported by the note; avoid unspecified when details exist.
  • Check payer policy and NCD/LCD rules; include conservative care attempts if required.

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Need more help? Reach out to us.

What does ICD‑10 M54.42 — Lumbago with sciatica, left side mean, and when is it appropriate to use?
When should I avoid unspecified variants of ICD‑10 M54.42 and select a more specific sub‑code?
Which related ICD‑10 or CPT concepts are commonly paired with ICD‑10 M54.42 in claims?
What documentation is required to code ICD‑10 M54.42 (Lumbago with sciatica, left side) accurately for medical necessity?
What common denial risks apply to ICD‑10 M54.42, and how can I prevent them with better notes?