ICD-10 Coding for Polymyalgia Rheumatica(M35.3)
Complete ICD-10-CM coding and documentation guide for Polymyalgia Rheumatica. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Polymyalgia Rheumatica
Key Information: ICD-10 code for polymyalgia rheumatica
Essential facts and insights about Polymyalgia Rheumatica
Primary ICD-10-CM Code for polymyalgia rheumatica
Decision Criteria
clinical Criteria
- Bilateral shoulder/hip pain with morning stiffness >45 minutes.
coding Criteria
- Use M35.3 as primary code if PMR is the main diagnosis.
Applicable To
- Bilateral shoulder and hip pain
- Morning stiffness >45 minutes
Excludes
- Giant Cell Arteritis (M31.5)
Clinical Validation Requirements
- ESR >40 mm/hr
- CRP >1 mg/dL
- Ultrasound showing bursitis
Code-Specific Risks
- Incorrectly using M79.1 when PMR criteria are met.
Coding Notes
- Ensure documentation includes specific symptoms and lab results.
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.
Giant Cell Arteritis
M31.5Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Polymyalgia Rheumatica to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M35.3.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure lab results are included in the patient's chart.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure all PMR criteria are documented before coding.
Impact
High audit risk if PMR criteria are not documented.
Mitigation Strategy
Ensure all criteria are documented in the patient's record.
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 Polymyalgia Rheumatica, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Polymyalgia Rheumatica
Use these documentation templates to ensure complete and accurate documentation for Polymyalgia Rheumatica. These templates include all required elements for proper coding and billing.
Rheumatology H&P
Specialty: RheumatologyRequired Elements
- History of present illness
- Physical examination
- Laboratory results
- Imaging findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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