ICD-10 Coding for Giant Cell Arteritis(M31.6, M31.5)
Complete ICD-10-CM coding and documentation guide for Giant Cell Arteritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Giant Cell Arteritis
M31.5-M31.6Primary Range
Other necrotizing vasculopathies
This range includes codes specific to giant cell arteritis and its variants, such as with polymyalgia rheumatica.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M31.6 | Other giant cell arteritis | Use when giant cell arteritis is diagnosed without polymyalgia rheumatica. |
|
| M31.5 | Giant cell arteritis with polymyalgia rheumatica | Use when both giant cell arteritis and polymyalgia rheumatica are documented. |
|
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 giant cell arteritis
Essential facts and insights about Giant Cell Arteritis
Primary ICD-10-CM Codes for giant cell arteritis
Decision Criteria
clinical Criteria
- Presence of cranial symptoms and elevated inflammatory markers
documentation Criteria
- Biopsy or imaging evidence of GCA
Applicable To
- Temporal arteritis
Excludes
- Giant cell arteritis with polymyalgia rheumatica (M31.5)
Clinical Validation Requirements
- Age ≥50 years
- Cranial symptoms such as headache or jaw claudication
- Elevated ESR ≥50 mm/hr or CRP ≥10 mg/dL
- Positive temporal artery biopsy or imaging
Code-Specific Risks
- Incorrectly coding M31.5 when PMR is not documented
Coding Notes
- Ensure documentation supports the absence of PMR when using M31.6.
M31.5 - Giant cell arteritis with polymyalgia rheumatica
Use when both giant cell arteritis and polymyalgia rheumatica are documented.
Applicable To
- GCA with PMR
Excludes
- Giant cell arteritis without PMR (M31.6)
Clinical Validation Requirements
- Documentation of both GCA and PMR symptoms
- Elevated ESR or CRP
- Biopsy or imaging evidence
Coding Notes
Ensure PMR is documented to use M31.5.
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 Giant Cell Arteritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M31.6.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Ensure biopsy results are included in the patient's record., Verify documentation completeness before coding.
Impact
Reimbursement: Incorrect coding may lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure PMR symptoms are documented before using M31.5.
Impact
Incomplete documentation of symptoms and lab results.
Mitigation Strategy
Implement thorough documentation practices and regular audits.
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 Giant Cell Arteritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Giant Cell Arteritis
Use these documentation templates to ensure complete and accurate documentation for Giant Cell Arteritis. These templates include all required elements for proper coding and billing.
Rheumatology Progress Note
Specialty: RheumatologyRequired Elements
- Chief complaint
- History of present illness
- Physical exam findings
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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