ICD-10 Coding for Fibromyalgia(M79.7, G89.4)
Complete ICD-10-CM coding and documentation guide for Fibromyalgia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fibromyalgia
M79.7Primary Range
Fibromyalgia
This is the primary ICD-10 code for diagnosing fibromyalgia, used for most clinical encounters unless the visit is specifically for pain management.
Pain, not elsewhere classified
Used when the primary purpose of the visit is pain management, such as opioid management or nerve blocks.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M79.7 | Fibromyalgia | Use when fibromyalgia is the primary focus of the encounter and not specifically for pain management. |
|
| G89.4 | Chronic pain syndrome | Use when the encounter is specifically for managing chronic pain related to fibromyalgia. |
|
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 fibromyalgia
Essential facts and insights about Fibromyalgia
Primary ICD-10-CM Codes for fibromyalgia
Decision Criteria
clinical Criteria
- Patient meets 2010 ACR criteria with documented WPI and SS scores.
coding Criteria
- Use M79.7 when fibromyalgia is the primary diagnosis and not specifically for pain management.
documentation Criteria
- Include exclusion of other rheumatic diseases in the documentation.
Applicable To
- Fibrositis
- Fibromyositis
Excludes
- Myalgia (M79.1)
Clinical Validation Requirements
- Widespread Pain Index (WPI) ≥7 and Symptom Severity (SS) ≥5 or WPI 3-6 and SS ≥9
- Symptoms present for ≥3 months
- Exclusion of other rheumatic diseases
Code-Specific Risks
- Using without proper documentation of WPI and SS scores
- Confusing with myalgia (M79.1)
Coding Notes
- Ensure documentation includes WPI and SS scores, duration of symptoms, and exclusion of other conditions.
G89.4 - Chronic pain syndrome
Use when the encounter is specifically for managing chronic pain related to fibromyalgia.
Clinical Validation Requirements
- Pain management is the primary reason for the encounter
Coding Notes
Ensure proper sequencing with M79.7 when pain management is the focus.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Depression, unspecified
F32.9Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Myalgia
M79.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fibromyalgia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M79.7.
Impact
Clinical: Inadequate documentation for diagnosis confirmation., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Use templates to ensure all criteria are documented, Regular training on documentation standards
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data and patient records.
Mitigation Strategy
Ensure documentation supports fibromyalgia diagnosis with WPI and SS scores.
Impact
Reimbursement: Improper sequencing can affect claim approval., Compliance: Violates ICD-10 sequencing rules., Data Quality: Leads to inaccurate data on patient care priorities.
Mitigation Strategy
Sequence G89.4 first only when the visit is for pain management.
Impact
Lack of documentation for WPI and SS scores can trigger audits.
Mitigation Strategy
Ensure all clinical notes include these scores and meet ACR criteria.
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 Fibromyalgia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fibromyalgia
Use these documentation templates to ensure complete and accurate documentation for Fibromyalgia. These templates include all required elements for proper coding and billing.
Routine fibromyalgia management
Specialty: RheumatologyRequired Elements
- WPI and SS scores
- Symptom duration
- Exclusion of other conditions
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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