Pain Management Coding Alert

Question: What is the difference between myalgia and fibromyalgia, and how do you choose an ICD-10 code for these conditions?

New York Subscriber

Answer: According to Codify “Myalgia refers to muscle pain associated with myofascial pain syndrome, which may occur in one or more muscles, generally due to injury of the muscle from excessive strain, repetitive motions, or as a result of stress. The provider does not document the site of myalgia.”

Also known as: Myalgia might also be referred to as myofascial pain syndrome in encounter notes.

You’ll choose one of the following diagnosis codes for myalgia, depending on encounter specifics:

• M79.10 — Myalgia, unspecified site
• M79.11 — Myalgia of mastication muscle
• M79.12 — Myalgia of auxiliary muscles, head and neck
• M79.18 — Myalgia, other site.

According to Codify, “fibromyalgia refers to pain in the muscles and soft tissues, which can be long term and severe pain, that can spread all over the body; it can be due to trauma, abnormal response to pain, sleep disturbance, or infection.”

Also known as: Fibromyalgia might also be referred to as fibromyositis, fibrositis, or myofibrositis in the encounter notes.

If you have a definite diagnosis of fibromyalgia, ICD-10 coding is a breeze: Choose M79.7 (Fibromyalgia) and you’re done, as it is the only fibromyalgia ICD-10 code.

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