ICD-10 Coding for Restless Legs Syndrome(G25.81)
Complete ICD-10-CM coding and documentation guide for Restless Legs Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Restless Legs Syndrome
G25.81Primary Range
Restless legs syndrome
This code is used for diagnosing and billing restless legs syndrome, capturing both idiopathic and secondary forms.
Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
Used when RLS is secondary to pregnancy.
Key Information: ICD-10 code for restless leg syndrome
Essential facts and insights about Restless Legs Syndrome
Primary ICD-10-CM Code for restless leg syndrome
Decision Criteria
clinical Criteria
- All four NIH criteria for RLS are met.
coding Criteria
- No secondary cause identified.
documentation Criteria
- Explicit documentation of symptoms and relief patterns.
Applicable To
- Idiopathic RLS
- Secondary RLS
Excludes
- Periodic limb movement disorder (G47.61)
Clinical Validation Requirements
- Urge to move legs
- Symptoms worsen at rest
- Partial relief with movement
- Worse in the evening or night
Code-Specific Risks
- Misdiagnosis with neuropathy
- Omitting secondary causes
Coding Notes
- Ensure all four NIH criteria are documented to support the use of G25.81.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Restless Legs Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G25.81.
Impact
Clinical: Misrepresentation of patient's condition., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always check for and document secondary causes.
Impact
Reimbursement: Claims may be denied due to insufficient documentation., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation includes all four NIH criteria for RLS.
Impact
Failure to document all criteria can lead to audit issues.
Mitigation Strategy
Implement checklist for NIH criteria in documentation.
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 Restless Legs Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Restless Legs Syndrome
Use these documentation templates to ensure complete and accurate documentation for Restless Legs Syndrome. These templates include all required elements for proper coding and billing.
Initial diagnosis of RLS
Specialty: Primary CareRequired Elements
- Patient history
- NIH criteria documentation
- Iron studies
- Family history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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