Fibromyalgia Coding - Key Points to Note

Healthcare providers find it difficult to accurately code fibromyalgia due to the intricacy, which calls for outsourced medical billing services for a streamlined operation.

Though not life-threatening, a majority of the patients potentially diagnosable with fibromyalgia approach medical care providers due to the hindrance of a smooth functioning at home or at jobs. 90% of the patients are seen with fatigue while another section with pain, stiffness, abnormal sleep patterns and other hassles seeking for a cure. Ironically, doctors are to convince their patients about the incurable nature of fibromyalgia the symptoms of which can only be managed with proper diagnosis and medication. The diverse and overlapping symptoms make fibromyalgia coding complicated. Medical billing services therefore become necessary to relieve the process for both providers and patients.

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ICD-10 Coding for Fibromyalgia

M79.7 is the ICD-10 code for fibromyalgia. It is a billable code that needs to be used on the medical claim for reimbursement purposes. Following are some of the key points to note while coding for fibromyalgia:

? While preparing the codes for diagnosis, one must be careful as the symptoms are subjective in nature and there are no objective test results or physical indicators. Focus must be given to documenting patient symptoms accurately as the diagnosis relies heavily on patient reporting.

? Regularly keep a check on the updates of ICD-10 coding system as alterations could occur. Refer sources such as AMA, ACR, AAPM etc. as well. The 2024 edition of ICD-10-CM M79.7 has been in effect since October 1, 2023.

? The ICD-10 code for fibromyalgia is applicable to Fibromyositis, Fibrositis and Myofibrositis as well.

Symptoms of Fibromyalgia

It must be noted that there is an overlap of symptoms between fibromyalgia and the chronic fatigue syndrome. Overlapping tends to happen in the case of other diseases as well; the irritable bowel syndrome being an example. Emotional or physical trauma are the main factors that trigger the symptoms which are crucial for proper diagnosis. The prominent symptoms along with ICD-10 codes are listed below:

? R20.2 Paresthesia of skin

? G43.909 migraine

? R53.83 Fatigue

? G47.9 Sleep disorders

? M25.60 Stiffness

Fibromyalgia symptoms can also occur as coexistent conditions or comorbidities as F32- Depression and F41-Anxiety. Widespread pain could also indicate the disease. Central sensitization is believed to be the reason for severe symptoms resulting in a lower threshold for pain, making the affected person over reactive to pain signals.

Diagnosis Process

Certain diagnostic criteria are to be followed by healthcare professionals while assessing a patient for fibromyalgia. It involves the below-given conditions:

? Widespread pain lasting for at least 3 months

? Presence of specified number of tender points (18 according to ACR)

? Severity of symptoms

? Impact on daily functioning and quality of life

? Exclusion of other conditions that could account to symptoms

For accurate evaluation, healthcare professionals utilize assessment tools such as Fibromyalgia Impact Questionnaire (FIQ) and Revised Fibromyalgia Impact Questionnaire (FIQR).

Fibromyalgia diagnostic algorithm or a series of systematic steps will be conducted for a clear diagnosis. Following these key steps helps in making a more precise reliable diagnosis, eliminating any errors. The key steps of the algorithm are given below:

Step1: Evaluate symptoms based on diagnostic criteria

Step2: Exclude other possible causes

Step3: Perform supplement diagnostic tests if necessary

Step 4: Apply standardized diagnostic criteria

Since symptoms are the only source for diagnosing the disease, there are certain tests and assessments utilized to aid the process of confirming the symptoms, such as the fibromyalgia Tender Points Examination to identify the tenderness and muscle pain. Added to that are the medical history evaluation, questionnaires, surveys and laboratory tests including imaging tests and blood tests. Precision-based diagnosis of fibromyalgia involves analyzing a combination of symptoms, tender points and other factors.

Treatment Codes

The non-curable nature of fibromyalgia doesn’t restrict the treatment possibilities. Easing of the symptoms is prioritized to subsequently diminish the impact. Some of the treatment methods along with their related CPT codes are given below.

? 97140- Myofascial release

? 20552 and 20553-Trigger point injections

? 90901- 90913- biofeedback services

? 97810- Manual acupuncture, 97813- Electro acupuncture

? 97124- massage therapy

The complexity of fibromyalgia as a disease with no cure, and unclear symptoms pose a challenge for doctors to comprehend the right coding. Common coding errors along with sole dependency of the patient’s verdict on symptoms increase the chance of claim denials. This calls for the need for medical billing services for better RCM and focus on the patients so as to easily ease the frustrations fibromyalgia imposes on their day-to-day lives.