Fibromyalgia ICD 10 Code

Refresher: What are ICD-10 codes?

The ICD-10, short for the International Classification of Diseases, is the 10th revision of medical codes prepared by the World Health Organization [¹]. It has over 68,000 codes, up to five times more than the code set found in ICD-9 at just over 13,000 codes. The ICD-10-CM is specific to US organizations and has been clinically modified for billing and payment processing [²].

The updated code set allows for more specificity and accuracy to help medical professionals provide accurate diagnoses. US physicians are required to use codes C00 through D49 for identifying neoplasms of various kinds, as listed below:

• A00 through B99 are used for classifying certain infections and parasitic disease
• C00 through C97 are used for classifying malignant neoplasms
• D00 through D09 are used for classifying in situ neoplasms
• D10 through D36 are used for classifying benign neoplasms
• D37 through D49 are used for classifying neoplasm of unknown or uncertain behavior
• F01 through F99 are used for classifying mental, behavioral, and neurodevelopmental disorders
• M00 through M99 are used for classifying diseases of the musculoskeletal system and connective tissue

All the ICD-10 codes are used to provide more data with accurate diagnostics and improve patient outcomes. It can be challenging for inexperienced medical personnel and coders to start using the new code set, which often requires significant time and capital investment in IT resources as well as certifications.

What is the ICD 10 code for M79.7?

For fibromyalgia, the general ICD-10 code is M79.7 (abnormal pain perception processing) and can be used synonymously with fibromyositis, fibrositis, and myofibrositis [³]. There is no other code in the ICD-10 code set for any other types of fibromyalgia.

Fibromyalgia ICD 10 code: M79.7

Fibromyalgia ICD code M79.7 lookup

Most soft tissue disorders are coded under M79 and include medical conditions like rheumatism (M79.0), myalgia (M79.1), and neuralgia (M79.2). However, fibromyalgia has no other code entries besides M79.7.

Studies show that fibromyalgia affects 2% of the adult population in the US (about 4 million people [⁴]. The exact causes of fibromyalgia are unknown, but the disease can be treated, and its symptoms managed if it is caught early [⁵]. Although anyone can develop fibromyalgia, it is more prevalent in women than in men.

Literature shows that fibromyalgia has become more prevalent worldwide [⁶].

Fibromyalgia will usually develop between the ages of 25 to 55, but people of all ages are likely to have the condition. The chronic disorder can cause pain and tenderness throughout the body and disrupt sleep patterns. This can create a vicious cycle where the patient constantly feels fatigued and unable to recover from their symptoms. Patients diagnosed with fibromyalgia often have a high risk of suicide.

Fibromyalgia is not a progressive disease which means it doesn't get worse with time and may even improve. It is not fatal and doesn't damage the muscles, internal organs, or joints. However, fibromyalgia can cause pain and a lower quality of life. Adults living with fibromyalgia often struggle with higher death rates due to suicide and injuries.

The exact symptoms of fibromyalgia will vary from patient to patient; however, most people are likely to encounter the following symptoms:

• Pain throughout the body that is described as a dull ache
• Feeling fatigued all the time
• Going through episodes of depression and anxiety
• Low quality of sleep with disrupted sleep patterns
• Problems with memory, concentration, thinking, and other cognitive difficulties
• Frequent headaches, including migraines

Fibromyalgia and its symptoms can coexist with other conditions, such as:

• Temporomandibular joint disorder
• Interstitial cystitis
• Headaches and migraine
• Chronic fatigue syndrome
• Irritable bowel syndrome
• Depression
• Anxiety
• Postural tachycardia system

It can be tricky to know if someone has fibromyalgia, and it can be fairly easy to misdiagnose the condition, even by expert doctors. This is because fibromyalgia isn’t the only condition that can cause widespread pain. A doctor’s examination is required for properly diagnosing fibromyalgia.

Fibromyalgia may be identified with a physical exam. At the time of writing, there are on specific imaging or laboratory tests for precisely identifying fibromyalgia. In general, patients should meet very specific criteria for a fibromyalgia diagnosis. Patients with fibromyalgia must have pain in at least four of the following five areas:

• Left upper region, including the arm, jaw, or shoulder
• Right upper region, including the arm, jaw, or shoulder
• Left lower region, including the buttock, leg, or hip
• Right lower region, including the buttock, leg, or hip
• The axial region, including the back, chest, abdomen, or neck

Doctors will use various tests to rule out other conditions that may have overlapping symptoms. The following blood tests may be performed:

• Erythrocyte sedimentation rate
• Cyclic citrullinated peptide test
• Thyroid function test
• Antinuclear antibody
• Blood count
• Vitamin D tests
• Celiac serology

The primary treatment for fibromyalgia is medication for relieving the pain and helping with sleep. Commonly used medications include:

• Pain relievers such as over-the-counter Tylenol and Motrin
• Antidepressants to relieve the pain and fatigue associated with fibromyalgia
• Anti-seizure drugs for treating epilepsy and reducing certain types of pain

In addition to these, patients may be prescribed various therapies to reduce the impact of fibromyalgia on their life. This includes physical therapy, counseling, and occupational therapy.

Types of Fibromyalgia coded under M79.7

The ICD 10 code M79.7 does not specify the subtype of fibromyalgia. An M79.7 code can be used for fibromyalgia of various types and pains:

• Myofibrositis
• Fibrositis
• Fibromyositis

In other words, myelofibrosis ICD 10, fibrositis ICD 10, and fibromyositis ICD 10 codes could all be M79.7 if they are determined to be nonarticular rheumatic conditions characterized by muscle pain, tenderness, and stiffness. As a concrete example, a patient diagnosed with fibromyositis would be coded with C79.7.

A quick comparison of the ICD-10 code set with its predecessor, the ICD-9, shows a slew of advantages for all stakeholders involved: healthcare providers, medical coders, and patients. For one, the ICD-10 aims to make medical diagnostics more consistent and uniform for healthcare professionals. This marks it easier to treat fibromyalgia.

A core objective of the ICD-10 code set is to make the storage of medical histories relatively easy. This allows medical professionals to retrieve the medical histories of patients to pick up where the previous healthcare professional left off, thus speeding up the diagnosis and treatment processes.

Despite its advantages, the ICD-10 system does have its fair share of disadvantages. For one, it can be relatively easy to miscode a medical condition if the coder is inexperienced. Using the ICD-10 requires access to high-tech infrastructure for using large volumes of data. Not all healthcare organizations may have the budget needed to install or use these IT systems.

This can pose several problems for the patient, including being administered the wrong medication that could expose them to undesirable side effects, allowing their medical condition to go untreated and get worsen over time, and lowering their quality of life.

Fibromyalgia, in particular, is difficult to identify and is one of the most commonly misdiagnosed medical conditions. In fact, one survey found that physicians had failed to correctly diagnose 49.6% of patients who met the ACR criteria for fibromyalgia [8].

It is also important to note that switching to the ICD-10-CM system can be very expensive. Service providers often charge a premium to healthcare organizations. The transition period for upgrading from ICD-9 to ICD-10 can also reduce productivity rates until all healthcare professionals are on board with the new system.

In addition, healthcare professionals may be required to undergo additional classes and training to receive certification for ICD-10-CM. This often means an investment of time and money, all of which can be restrictive for busy healthcare professionals. However, by all accounts, upgrading to ICD-10-CM can be very advantageous to healthcare professionals, medical coders, and patients despite the mentioned disadvantages.

Soft tissue disorders excluded from ICD-10 C79.7

Below is a list of soft tissue disorders that are excluded from ICD-10 C78.7:

Conclusion

The ICD-10 code for fibromyalgia is C79.7, with no other codes. Given the difficulty of diagnosing fibromyalgia, you should visit a medical doctor to verify if your symptoms meet the minimum criteria for the medical condition.

Note that the information provided in this article is not meant for self-diagnosis and does not replace professional medical advice from a healthcare expert. For more information, please visit your doctor for detailed diagnostics, including information about the ICD-10 codes mentioned here.