Excludes1 pair
M54.4- vs M79.2
M54.4 and M79.2 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
The official note, declared on M79.2
sciatica (M54.3-M54.4)
M54.4
Lumbago with sciatica
Not billable
- Chapter 13
- Diseases of the musculoskeletal system and connective tissue
- Section
- M50-M54
Indexed under
- Lumbago, lumbalgia › with sciatica
- Rheumatism › sciatic
- Sciatica › with lumbago
- Scoliosis › sciatic
- Pain › spine › low back › with sciatica
M79.2
Neuralgia and neuritis, unspecified
BillableUnspecified
- Chapter 13
- Diseases of the musculoskeletal system and connective tissue
- Section
- M70-M79
Indexed under
- Neuralgia, neuralgic (acute)
- Neuritis (rheumatoid)
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027