Pain Management Coding Alert

Question: An established patient who has a temporomandibular joint (TMJ) disorder reports for an evaluation and management (E/M) service. Notes indicate that the condition was, specifically, “TMJ, arthralgia, 2-sided.” During the E/M, the provider performed a problem-focused examination and history. What ICD-10 and CPT^® codes should I report for this encounter?

Wisconsin Subscriber

Answer: This looks like a bilateral, or “two-sided,” TMJ encounter; and you’ll only need a single diagnosis code, since ICD-10 added a code to indicate bilateral TMJ of this type a few years ago.

On your 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making…) claim, report M26.623 (Arthralgia of bilateral temporomandibular joint). This code represents bilateral (“two-sided”) TMJ arthralgia. 

Note: If a patient has unilateral, or “one-sided,” TMJ arthralgia, you’ll choose from one of the following codes for the condition:

• M26.621 (Arthralgia of right temporomandibular joint)
• M26.622 (Arthralgia of left temporomandibular joint)
• M26.629 (Arthralgia of temporomandibular joint, unspecified side).

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