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Home/Diagnosis/ICD-10 Coding for Muscle Pain

ICD-10 Coding for Muscle Pain

M79.10
M79.11
M54.5

Complete ICD-10-CM coding and documentation guide for icd-10 coding for muscle pain includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Myalgia
Muscular Pain
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Key Information: ICD-10 Coding for Muscle Pain

Essential facts and insights about ICD-10 Coding for Muscle Pain

Use ICD-10 code M79.10 for myalgia, unspecified, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Myalgia, unspecified

Billable Code
M79.10
Billable

Diagnostic Criteria

documentation_criteria:
  • • Lack of specific site documentation.
applicable_to:
  • • Generalized muscle pain
excludes:
  • • Fibromyalgia (M79.7)
validation:
  • • Documentation of muscle pain without specific localization.
notes:
  • • Ensure documentation supports the use of an unspecified code.
risks:
  • • Overuse of unspecified code may lead to reimbursement issues.

Myalgia of mastication muscle

Billable Code
M79.11
Billable

Diagnostic Criteria

applicable_to:
  • • Jaw muscle pain
excludes:
  • • Temporomandibular joint disorders (K07.6)
validation:
  • • Documentation of pain in the muscles of mastication, often associated with TMJ dysfunction.
notes:
  • • Ensure TMJ dysfunction is not the primary diagnosis.

Low back pain

Non-Billable
M54.5
Non-Billable

Diagnostic Criteria

applicable_to:
  • • Lumbago
excludes:
  • • Sciatica (M54.3)
validation:
  • • Documentation of pain localized to the lumbar region.
notes:
  • • Document any associated radiculopathy separately.
Frequently Asked Questions

What is the ICD-10 code for muscle pain?

The ICD-10 code for unspecified muscle pain is M79.10. For specific sites, use codes like M79.11 for mastication muscle pain.

How do you code chronic muscle pain?

For chronic muscle pain, use G89.2 as the primary code if the encounter is for pain management, with site-specific codes as secondary.

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