Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the PM physician provided an office evaluation and management (E/M) service that lasted 44 minutes and included moderate medical decision making (MDM). Final diagnosis was “myofibrositis.” How should I code this claim? I’m not familiar with that diagnosis.

South Carolina Subscriber

Answer: Your ICD-10 code will be M79.7 (Fibromyalgia). The alternate terms for M79.7 are fibromyositis, fibrositis, and myofibrositis.

The E/M code you choose, however, isn’t as clear-cut. If the patient was new, report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.) for the E/M. If the patient was established, you’ll report 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/ or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) for the E/M.