ICD-10 Coding for Costochondritis(M94.0)
Complete ICD-10-CM coding and documentation guide for Costochondritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Costochondritis
M94.0Primary Range
Chondrocostal junction syndrome [Tietze]
This range includes costochondritis and Tietze's syndrome, which are often clinically similar but may differ in the presence of swelling.
Key Information: ICD-10 code for costochondritis
Essential facts and insights about Costochondritis
Primary ICD-10-CM Code for costochondritis
Decision Criteria
clinical Criteria
- Presence of reproducible tenderness at the costochondral junction
coding Criteria
- Use M94.0 if costochondritis is confirmed and documented
documentation Criteria
- Document negative cardiac workup to rule out other causes
Applicable To
- Costochondritis
- Tietze's syndrome
Clinical Validation Requirements
- Reproducible tenderness at costochondral junction
- Absence of cardiac pathology
- Normal ECG and cardiac biomarkers
Code-Specific Risks
- Confusion with chest pain codes if not properly documented
- Misclassification if swelling is present (consider Tietze's)
Coding Notes
- Ensure documentation specifies the location and nature of tenderness to differentiate from other chest pain causes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Costochondritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M94.0.
Impact
Clinical: Misdiagnosis of cardiac conditions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Ensure all cardiac tests are documented in the patient's record.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement rates., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use only M94.0 if costochondritis is the confirmed diagnosis.
Impact
Inaccurate or incomplete documentation may lead to audit findings.
Mitigation Strategy
Regular training on documentation standards and audit preparation.
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 Costochondritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Costochondritis
Use these documentation templates to ensure complete and accurate documentation for Costochondritis. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Chest Pain
Specialty: Emergency MedicineRequired Elements
- History of present illness
- Physical examination findings
- Diagnostic test results
- Final diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Costochondritis? Ask your questions below.