How to Diagnose Fibromyalgia? What Diagnosis Code for Fibromyalgia Is Used to Identify the Disease?

The diagnosis of fibromyalgia through ICD-10 and ICD-9 codes has been made easy for practitioners dealing with fibromyalgia. When all you need is to bill for the fibromyalgia in your claims, you need to note each and every step included in the diagnosis of fibromyalgia to use the diagnosis code for fibromyalgia efficiently.

However, knowing the diagnosis truly means that you know the disease completely first and its symptoms to treat. The article includes all the bits of information you need about fibromyalgia, diagnosis, symptoms and the diagnosis code for fibromyalgia.

What is fibromyalgia?

Fibromyalgia is a condition characterized by chronic pain and fatigue. It can be difficult to diagnose, as there is no definitive test for the condition. However, doctors can use a number of different methods to diagnose fibromyalgia, including a patient’s medical history, physical examination, and lab tests.

One of the most important tools for diagnosing fibromyalgia is the ICD-10, a code used by doctors to categorize diseases. The ICD-10 code for fibromyalgia is M79.7. This code is used to describe a disorder that is characterized by chronic pain and fatigue. The ICD-10 code is important because it helps doctors accurately diagnose fibromyalgia and track the progress of the disease.

What is fibromyalgia
source:creakyjoints.org

In order to be diagnosed with fibromyalgia, a person must have had chronic pain for at least three months. The pain must also be widespread, affecting both sides of the body and the upper and lower body. In addition, the pain must be accompanied by at least one other symptom, such as fatigue, difficulty sleeping, or memory problems.

The code is assigned by a doctor after a patient has undergone a complete medical evaluation. The evaluation must rule out other possible causes of the symptoms, such as arthritis or a spinal injury.

In other words, a disorder where a patient suffers chronic pain and stiffness all over his body. Chronic disease affects both genders regardless of age and location but mostly it is found in women. The main purpose of fibromyalgia is a lack of physical activity or exposure to not suitable weather conditions. The suffering is also called fibromyalgia syndrome.

Some other fibromyalgia symptoms include;

  • Trouble in sleeping
  • Fatigue
  • Headache
  • Sleeping for a long time without feeling fresh
  • Dry eyes
  • Mood disorders
  • Bladder disorders

People suffering from fibromyalgia usually feel constant pain as their brain multiplies pain signals continuously. Practitioners diagnose this disorder as a primary or secondary cause of fibromyalgia.

To cure the pain and diagnose the disease efficiently, it becomes necessary for the patient to visit multiple doctors until fibromyalgia gets diagnosed. The process of diagnosing fibromyalgia can be frustrating for patients as there is no direct test that diagnoses fibromyalgia from the first exposure because the core symptoms that the patient may feel can be the reason for any other disease as well.

Hence, it becomes mandatory for physicians to determine the cause of symptoms and diagnose fibromyalgia by checking the whole checklist of tests and symptoms for the disease. For this wide process of diagnosis of fibromyalgia, certain tools are there that providers use for the purpose;

  • Complete physical examination
  • Blood tests and radiology tests to identify other conditions.
  • Access to medical history that may identify the whole symptoms of the disease

Diagnosis Code for Fibromyalgia

To proper diagnosis of fibromyalgia, the requirement from A to B must be fulfilled;

  • A – Persistent suffering from pain (equal to or more than three months) not limited to one part of the body
  • B.1 – Chronic pain is becoming the reason for emotional distress
  • B.2 – Due to pain, the activities of a normal life are hindered, and pain interferes with social participation.
  • C – The pain causes sleep disorder, and somatic symptoms, and is associated with cognitive dysfunction
  • D – Another chronic condition may trigger the pain

Part D of the above-mentioned reports are there that the conditions such as;

  • Injury
  • Surgery
  • Infection
  • Emotional stress

It can trigger chronic disease at any time. As mentioned earlier that fibromyalgia can happen to anyone regardless of gender, but it commonly occurs in;

  • Adults
  • Women – because they have a higher tendency to grow fibromyalgia
  • Individuals with a family history of fibromyalgia
  • Individuals with the health condition like lupus, rheumatoid arthritis, or ankylosing spondylitis

However, the treatment for fibromyalgia involves strategies to implement for self-care and medication. The medication that is used in fibromyalgia treatment include;

Antidepressants – Milnacipran (Savella) and Duloxetine (Cymbalta) are two depressants that are widely used to treat fibromyalgia as they help in fatigue and pain relief associated with the chronic disease. In order to promote sleep, physicians may also prescribe muscle relaxants cyclobenzaprine or amitriptyline.

Pain Relievers – Over-the-counter like ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others), or naproxen sodium (Aleve, others) would be significantly helpful in managing fibromyalgia. Plus, physicians do not suggest opioids because they lead to significant dependence and side effects that worsen the suffering with time.

Anticonvulsants – Many other types of pain such as epilepsy are treated using medication and their outcomes are considerable for all pain types. Gabapentin (Neurontin) can also be helpful in the reduction of pain caused by fibromyalgia and minimize the symptoms. Besides, the first drug that the United States Food and Drug Administration approved to use in the treatment of fibromyalgia was pregabalin (Lyrica).

Some other treatments include;

  • Occupational therapy
  • Physical therapy
  • Counseling

Diagnosis code for fibromyalgia – The details of ICD-10

The updated ICD-10 code used for fibromyalgia is M79.7. ICD-10 codes are used in the claims for reimbursements for the services rendered by the physicians. Fibromyalgia diagnosis code M79.7 is also a billable code used for fibromyalgia medical services provided.

However, M79.7 is valid till the 2022 fiscal year which starts on October 1, 2021, and ends on September 30, 2022. If you have been diagnosing fibromyalgia in the period between time, check your state regulations about claiming services for HIPAA transactions coverage.

These fibromyalgia codes for ICD-10 can be found in the XIII chapter of the ICD-10 Book of Diseases under the block M60-M79 for musculoskeletal system and connective tissue (M00-M99). The book also provides codes for tissue disorder which lies in the category M70-M79, these codes are used in the claims for other soft tissue issues and disorders.

M79.9, not only limits itself to fibromyalgia but can also be used for other health conditions such as fibrositis, fibromyositis, nodular fasciitis, nodular fasciitis, fibrositis of the neck, and fibrositis arm.

Diagnosis Code for Fibromyalgia
source:painscale.com

As far as fibromyalgia is concerned, it is specifically conditioned under M79 determining general and unspecified tissue disorders for which no other ICD-10 codes are determined. The classification of M79 includes the following subgroups;

  • Rheumatism, unspecified.
  • Myalgia
  • Neuralgia and neuritis, unspecified.
  • Panniculitis, unspecified.
  • Hypertrophy of (infrapatellar) fat pad.
  • Residual foreign body in soft tissue.
  • Pain in limb, hand, foot, fingers, and toes.
  • Fibromyalgia
  • Other specified soft tissue disorders.
  • Soft tissue disorder, unspecified.
  • Nontraumatic compartment.

ICD-10 codes for chronic fatigue syndrome

The ICD-10 code used for chronic fatigue syndrome diagnosis is R53.82. This specific code is used for listing chronic fatigue syndrome

treatment and diagnosis. R53.82 has a place in XVIII of the ICD 10 Book where the codes for signs, symptoms, and unusual clinical laboratory findings are listed (R00-R99) which cannot be found elsewhere.

The codes are on the block R50-R69 where the Genera signs and symptoms of chronic fatigue are gathered.

The list of subgroup lies under this category includes;

  • R53.0 – Neoplastic (malignant) related fatigue
  • R53.1 – Weakness
  • R53.2 – Functional quadriplegia
  • R53.8 – Other malaise and fatigue

Other malaise and fatigue:

  • R53.81 – Other malaise seven indications for 482 drugs R53.81
  • R53.82 – Chronic fatigue, unspecified one indication for 49 drugs
  • R53.83 – Other fatigue.

ICD-11 codes for fibromyalgia

When the pain is widespread to the whole body, the diagnostic code for chronic pain under fibromyalgia would be MG30.01.

However, this kind of chronic pain for fibromyalgia doesn’t have any specific code in ICD 11. For this, the code was initially relocated to chapters in ICD 10 under the chronic pain category.

This is why it is now used as an inclusion term for chronic widespread pain under MG30.01.

The exact code for the diagnosis can be identified by adhering to the following steps;

ICD 11 book Chapter 21 where the signs, unusual clinical findings, and symptoms are listed with codes used.

Under the same block where the codes for signs and symptoms are coded under the code (MG20-MG9Y) – plus, the general symptoms are coded as (MG20-MG4Y).

Generally, these codes are encountered as the symptoms and signs in medical healthcare practice.

ICD codes between the MG20-MG4Y category include;

  • Cachexia (MG20)
  • Chills (MG21)
  • Fatigue (MG22)
  • Fear of death or dying (MG23)
  • Fear of disease (MG24)
  • Feeling ill (MG25)
  • Fever of other or unknown origin (MG26)
  • Hemorrhage, not elsewhere classified (MG27)
  • Hypothermia, not associated with low environmental temperature (MG28)
  • Edema(MG29)
  • Old age (MG2A)
  • Pain (MG30-MG3Z)
  • Shock (MG40)
  • Sleep disturbance, not elsewhere classified (MG41)
  • Somnolence, not elsewhere classified (MG42)
  • Symptoms and signs concerning food and fluid intake (MG43)
  • Symptoms peculiar to infancy (MG44)
  • Syncope and collapse (MG45)
  • Systemic inflammatory response syndrome of noninfectious origin (MG46)
  • Toxicosis not further specified (MG47)
  • Morbidity unknown and unspecified causes (MG48)
  • Other specified general symptoms (MG4Y)
  • The code for fibromyalgia is located under the coding system for Pain (MG30-MG3Z).

Chronic Pain included codes are;

  • Pain, unspecified (MG3Z)
  • Chronic pain (MG30)
  • Acute pain (MG31)

However, the codes that are excluded from the chronic pain group include;

Headache (8A80-8A8Z)

  • Abdominal or pelvic pain (MD81)
  • Breast pain (GB23.5)
  • Pain in joint (ME82)
  • Pain in the eye (MC18)
  • Ear pain (AB70.2)
  • Pain in the chest (MD30)
  • Pelvic or perineal pain (MD81.11)
  • Pain in the shoulder (ME82)
  • Spinal pain (ME84)
  • Pain in the tooth, toothache (DA0A)
  • Renal colic (MF56)
  • Pain in the throat (MD36.0)
  • Low back pain(ME84.2)
  • Pain in limb (FB56.4)
  • Pain disorders (8E43)

In addition, as fibromyalgia is also chronic pain, it is also listed under the chronic pain category of MG30.0. For tissue-related chronic pain, codes that are used include;

  • Chronic primary pain (MG30.0)
  • Chronic cancer-related pain (MG30.1)
  • Chronic postsurgical or post-traumatic pain (MG30.2)
  • Chronic secondary musculoskeletal pain (MG30.3)
  • Chronic secondary visceral pain (MG30.4)
  • Chronic neuropathic pain (MG30.5)
  • Chronic secondary headache or orofacial pain (MG30.6)
  • Other specified chronic pain (MG30.Y)
  • Chronic pain, unspecified (MG30.Z)
  • Chronic pain is pain that has lasted at least three months.
  • Selecting MG30.0, that is, chronic primary pain gives the following subgroup:
  • Chronic primary visceral pain (MG30.00)
  • Chronic widespread pain (MG30.01)
  • Chronic primary musculoskeletal pain (MG30.02)
  • Chronic primary headache or orofacial pain (MG30.03)
  • Other specified chronic primary pain (MG30.0Y)
  • Chronic primary pain, unspecified (MG30.0Z)
  • 01 chronic widespread pain has the following synonyms:
  • Chronic widespread pain
  • Fibromyalgia syndrome
  • Fibrositis
  • Fibrositis syndrome
  • Myofascial pain syndrome
  • Fibromyalgia, multiple sites
  • Fibromyositis
  • Myofibrositis

Ending note

Fibromyalgia reports are surging because of the symptoms of fibromyalgia are connected to other diseases as well. This is why while using diagnosis codes for fibromyalgia, there’s a dire need of understanding every code to reduce the chances of claim denials. To ensure this doesn’t happen, hiring a chiropractic billing service would be a great option. Plus, outsourcing your revenue process to experts will ease your burden to a great extent.