Fibromyalgia ICD 10 coding is made easier with our billing guidelines. This article includes all medical codes you will need to report Fibromyalgia and related specific ICD 10 codes such as chronic fatigue fibromyalgia syndrome ICD 10. Read on to get a summary of the necessary ICD 10 & 11 codes followed by a further description.
What Is Fibromyalgia?
Fibromyalgia is a disorder of chronic, widespread pain and tenderness all over the body. It typically presents in young or middle-aged women but can affect patients of either sex and age.
The muscle pain in fibromyalgia is typically aggravated by inactivity or exposure to cold. It can also be called fibromyalgia syndrome.
Other symptoms of fibromyalgia may include:
- Trouble falling asleep
- Sleeping for a long period without feeling refreshed.
- Mood disorder
- Dry eyes
- Bladder disorders like interstitial cystitis
In people with fibromyalgia, the brain usually amplifies pain signals. It may arise as a primary or secondary disease process.
Fibromyalgia can be difficult to diagnose. Sometimes it is necessary to visit various health care providers for a diagnosis. One setback is that there is no direct test to make diagnoses of fibromyalgia.
And the core symptoms, pain, and fatigue are also associated with many other disease conditions.
Therefore, health care providers should identify other causes of symptoms before diagnosing fibromyalgia. This is referred to as making a differential diagnosis.
A healthcare provider can use certain tools to make a diagnosis:
Full medical history includes asking specific questions about symptoms the patient presents with:
- General Physical examination
- Radiological and blood tests to rule out other disease conditions
For the diagnostic criteria for fibromyalgia, conditions A to D must be fulfilled:
- A. Chronic pain (persistent or recurrent for longer than three months) is present in at least 4 of 5 body regions
- B. The pain is associated with at least one of the following:
B.1 Emotional distress due to pain is present.
B.2 The pain interferes with daily life activities and social participation.
- C. The pain is associated with sleep disorders, cognitive dysfunction, and somatic symptoms
- D. Another chronic pain condition does not better account for the pain.
The exact etiology of fibromyalgia is unknown, but it is believed to be related to abnormal neurotransmitter levels in the brain and changes in the way the central nervous system (the brain, spinal cord, and nerves) processes pain messages carried around the body.
It is also suggested that some patients are more prone to fibromyalgia development because of genes inherited from their parents.
Sometimes, fibromyalgia may be triggered by other conditions such as:
- Emotional stress.
Anyone can get fibromyalgia, but it is very common in:
- Women; have an increased tendency of developing fibromyalgia
- Individuals with some disease conditions, such as rheumatoid arthritis, lupus, or ankylosing spondylitis
- Individual with a family member with fibromyalgia
In general, treatments for fibromyalgia include both medication and self-care strategies. Drugs used in the treatment of fibromyalgia include:
Pain relievers: Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), or naproxen sodium (Aleve, others) may be helpful. Opioid medications are not recommended because they can lead to significant side effects and dependence and worsen the pain over time.
Antidepressants: Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.
Anticonvulsants: Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.
While other therapies include:
- Physical therapy
- Occupational therapy
Fibromyalgia ICD 10 Code
The ICD 10 code for fibromyalgia is M79.7. It is a billable diagnostic code used to code a medical diagnosis of fibromyalgia.
Code M79.7 is valid for the 2022 fiscal year from 01 October 2021 to 30 September 2022 to deliver HIPAA transactions coverage.
This code can be found in chapter XIII of the ICD 10 book Diseases of the musculoskeletal system and connective tissue (M00-M99) under the block M60-M79, which codes for Soft tissue disorders and the category M70-M79, which codes for Other soft tissue disorders.
M79.7 might also be used to code conditions or terms like fibromyalgia, fibromyositis, fibrositis, fibrositis and nodular fasciitis, fibrositis arm, fibrositis of the neck.
Fibromyalgia is specifically located under M79, representing other and unspecified soft tissue disorders not elsewhere classified. The subgroups under this classification include:
M79.0 – Rheumatism, unspecified.
M79.1 – Myalgia
M79.2 – Neuralgia and neuritis, unspecified.
M79.3 – Panniculitis, unspecified.
M79.4 – Hypertrophy of (infrapatellar) fat pad.
M79.5 – Residual foreign body in soft tissue.
M79.6 – Pain in limb, hand, foot, fingers, and toes.
M79.7 – Fibromyalgia
M79.8 – Other specified soft tissue disorders.
M79.9 – Soft tissue disorder, unspecified.
M79.A – Nontraumatic compartment.
The ICD 10 for chronic fatigue syndrome is R53.82. R53.82 is a specific ICD 10 code that can indicate the diagnosis of chronic fatigue syndrome.
It can be found in chapter XVIII of the ICD 10 book, which codes for Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99).
It can be found in the block R50-R69, which codes for General symptoms and signs. The category R53 codes for malaise and fatigue.
The subgroup under this category include:
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
Fibromyalgia ICD 11 Code
The current ICD 11 code for fibromyalgia is MG30.01. This is the general code for widespread chronic pain.
For ICD 11, Fibromyalgia has not been assigned a unique code. Instead, it was relocated from its ICD 10 chapter location to a new category block in the Symptoms, signs chapter as an Inclusion term under Chronic pain.
It is currently coded as an Inclusion term under MG30.01 Chronic widespread pain.
This can be selected by following the following steps:
Chapter 21 of the ICD 11 book, which codes for symptoms, signs, or clinical findings, not elsewhere classified and is coded.
Under the block, General symptoms, signs, or clinical findings coded as (MG20-MG9Y), the category General symptoms coded as (MG20-MG4Y).
This generally codes for many symptoms encountered in medical practice. codes in this section (MG20-MG4Y) include:
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)
Old age (MG2A)
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)
Unknown and unspecified causes of morbidity (MG48)
Other specified general symptoms (MG4Y)
The code for fibromyalgia is located under the coding system for Pain (MG30-MG3Z).
Codes under this pain include:
- Chronic pain (MG30)
- Acute pain (MG31)
- Pain, unspecified (MG3Z)
This coding group excludes the following types of pain:
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)
Fibromyalgia is chronic pain. Thus, it is located under chronic pain as MG30.0, which codes for Chronic primary pain. Other forms of chronic pain 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)
MG30.01 chronic widespread pain has the following synonyms:
Chronic widespread pain
Myofascial pain syndrome
Fibromyalgia, multiple sites
Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions. It is associated with significant emotional distress (anxiety, anger/frustration, or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles).
Chronic widespread pain is multifactorial: biological, psychological, and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions.
There are features consistent with nociplastic pain and identified psychological and social contributors.
Thus, fibromyalgia syndrome is synonymous with widespread chronic pain in ICD 11.
– Dr. Quazim Omisore,
Medical Professional & Coding Expert