ICD-10 Coding for Myalgia(M79.10, M79.11, M79.12, M79.18)
Complete ICD-10-CM coding and documentation guide for Myalgia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Myalgia
M79.10-M79.18Primary Range
Myalgia
This range covers all ICD-10 codes for myalgia, specifying different anatomical sites.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M79.10 | Myalgia, unspecified site | Use when muscle pain is present but the specific site is not documented. |
|
| M79.11 | Myalgia of mastication muscles | Use when myalgia is specifically in the muscles of mastication. |
|
| M79.12 | Myalgia of auxiliary muscles, head and neck | Use when myalgia is specifically in the neck or auxiliary muscles. |
|
| M79.18 | Other site myalgia | Use when myalgia is in specific muscles not covered by other codes. |
|
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 unspecified myalgia
Essential facts and insights about Myalgia
Primary ICD-10-CM Codes for myalgia
Decision Criteria
documentation Criteria
- Lack of specific site documentation
Clinical Validation Requirements
- Documentation of muscle pain without specific site
- Exclusion of other specific conditions like fibromyalgia
Code-Specific Risks
- Overuse of unspecified code leading to audit risks
Coding Notes
- Ensure documentation specifies the absence of specific site information.
M79.11 - Myalgia of mastication muscles
Use when myalgia is specifically in the muscles of mastication.
Applicable To
- Pain in jaw muscles
Excludes
- Temporomandibular joint disorders (K07.6)
Clinical Validation Requirements
- Pain worsens with chewing
- Tenderness in masseter muscles
Coding Notes
Ensure documentation specifies pain in jaw muscles.
M79.12 - Myalgia of auxiliary muscles, head and neck
Use when myalgia is specifically in the neck or auxiliary muscles.
Applicable To
- Pain in neck muscles
Excludes
- Cervicalgia (M54.2)
Clinical Validation Requirements
- Stiffness when turning head
- Tenderness in trapezius muscles
Coding Notes
Ensure documentation specifies pain in neck muscles.
M79.18 - Other site myalgia
Use when myalgia is in specific muscles not covered by other codes.
Applicable To
- Pain in specific muscle groups not classified elsewhere
Excludes
- Myositis (M60.9)
Clinical Validation Requirements
- Exercise-induced muscle pain
- Normal CK levels
Coding Notes
Ensure documentation specifies the specific muscle group affected.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain, not elsewhere classified
G89.29Differential 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 Myalgia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M79.10.
Impact
Clinical: Leads to inaccurate diagnosis and treatment., Regulatory: Increases risk of coding audits., Financial: Potential for claim denials due to unspecified coding.
Mitigation Strategy
Train staff on documentation requirements., Use templates that prompt for specific site information.
Impact
Reimbursement: May lead to denied claims due to lack of specificity., Compliance: Increases risk of audit due to unspecified coding., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Use specific site codes like M79.11 or M79.12 when the site is documented.
Impact
Reimbursement: Incorrect coding can lead to claim rejections., Compliance: Violates coding guidelines for exclusivity., Data Quality: Compromises the integrity of patient records.
Mitigation Strategy
Do not use M79.10 with M79.7; choose the most appropriate code.
Impact
Frequent use of M79.10 without specific site documentation.
Mitigation Strategy
Encourage use of specific site codes when possible.
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 Myalgia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Myalgia
Use these documentation templates to ensure complete and accurate documentation for Myalgia. These templates include all required elements for proper coding and billing.
Chronic myalgia management
Specialty: Pain ManagementRequired Elements
- Subjective pain description
- Objective findings
- Assessment with ICD-10 codes
- Plan including treatments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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