ICD-10 Coding for Calf Pain(M79.642, M79.652, I80.211)
Complete ICD-10-CM coding and documentation guide for Calf Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Calf Pain
M79.60-M79.66Primary Range
Other and unspecified soft tissue disorders, not elsewhere classified
This range includes codes for pain in specific areas of the leg, including the calf.
Phlebitis and thrombophlebitis
Includes codes for deep vein thrombosis, which can present with calf pain.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M79.642 | Pain in right calf | Use when the pain is localized to the right calf and no other specific condition is identified. |
|
| M79.652 | Pain in left calf | Use when the pain is localized to the left calf and no other specific condition is identified. |
|
| I80.211 | Phlebitis and thrombophlebitis of right femoral vein | Use when DVT is confirmed as the cause of calf pain. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for right calf pain
Essential facts and insights about Calf Pain
Primary ICD-10-CM Codes for calf pain
Decision Criteria
clinical Criteria
- Pain localized to the right calf with no other specific diagnosis
documentation Criteria
- Laterality must be specified
Applicable To
- Right calf pain
Excludes
- Pain in right lower leg (M79.661)
Clinical Validation Requirements
- Documentation of right calf pain
- Laterality specified
- Absence of other specific conditions like DVT unless confirmed
Code-Specific Risks
- Risk of using unspecified codes when laterality is known
Coding Notes
- Ensure laterality is documented to avoid unspecified codes.
M79.652 - Pain in left calf
Use when the pain is localized to the left calf and no other specific condition is identified.
Applicable To
- Left calf pain
Excludes
- Pain in left lower leg (M79.662)
Clinical Validation Requirements
- Documentation of left calf pain
- Laterality specified
- Absence of other specific conditions like DVT unless confirmed
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
I80.211 - Phlebitis and thrombophlebitis of right femoral vein
Use when DVT is confirmed as the cause of calf pain.
Applicable To
- DVT of right calf veins
Excludes
- Superficial thrombophlebitis (I80.0)
Clinical Validation Requirements
- Doppler ultrasound confirmation
- Clinical signs of DVT
Coding Notes
Ensure imaging confirmation is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Calf Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M79.642.
Impact
Clinical: Leads to incomplete clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Use documentation templates that require laterality., Educate providers on the importance of specifying laterality.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases the accuracy of clinical data.
Mitigation Strategy
Always specify laterality in documentation and use the appropriate specific code.
Impact
Reimbursement: Claims may be denied if imaging is not documented., Compliance: Violates coding guidelines requiring clinical validation., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Ensure Doppler ultrasound or other imaging confirms DVT before coding.
Impact
Audits may focus on the use of unspecified codes when specific codes are available.
Mitigation Strategy
Ensure documentation includes all necessary details to support specific coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Calf Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Calf Pain
Use these documentation templates to ensure complete and accurate documentation for Calf Pain. These templates include all required elements for proper coding and billing.
Calf Strain
Specialty: OrthopedicsRequired Elements
- Onset and duration of pain
- Location and laterality
- Aggravating and relieving factors
- Physical examination findings
- Differential diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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