Polymyalgia Rheumatica ICD-10-CM Codes | 2023

What ICD-10 Codes are Used for Polymyalgia Rheumatica

Polymyalgia Rheumatica (PMR) is an inflammatory condition that primarily affects the muscles and can cause significant pain and stiffness, especially in the shoulders, neck, and hips. Several specific codes are used to code for PMR in the ICD-10 system. 

Here are the commonly used PMR ICD-10 codes, along with their clinical descriptions:

• M35.3: Polymyalgia rheumatica: This is the primary code for PMR and indicates the presence of the condition characterized by pain, stiffness, and inflammation in the shoulders, neck, and hips.
• M35.31: Polymyalgia rheumatica with codes l2y Amylase (HLA-DR4) genotype: This code specifies the presence of specific genetic markers associated with PMR, which can help in understanding the patient's genetic predisposition.
• M35.32: Polymyalgia rheumatica with diffuse pigmented villonodular synovitis: This code is used when PMR is accompanied by a rare condition called pigmented villonodular synovitis involving joint inflammation.
• M35.39: Other polymyalgia rheumatica: This code is employed when the presentation of PMR differs from the typical symptoms, such as involvement of other joints or atypical clinical features.
• M79.0: Rheumatism, unspecified: This code may be used when the symptoms resemble musculoskeletal rheumatism but don't fit precisely into the PMR category.
• M79.1: Myalgia: When patients primarily complain of muscle pain but a specific diagnosis of PMR is not established, this code can be utilized.
• M79.2: Neuralgia and neuritis, unspecified: In cases where nerve pain is prominent, this code may describe the symptoms associated with PMR.
• M79.7: Fibromyalgia: Fibromyalgia shares some symptoms with PMR, including muscle pain and tenderness, and may require this code for accurate diagnosis.
• M79.9: Soft tissue disorder, unspecified: If the exact nature of the soft tissue disorder is unclear, this code is a suitable choice.
• G56.01: Carpal tunnel syndrome, right upper limb: Sometimes, PMR patients may experience symptoms resembling carpal tunnel syndrome in the upper limbs, and this code helps differentiate these symptoms.

When coding for PMR, healthcare providers should choose the most appropriate code based on the specific clinical presentation and any associated conditions. Accurate coding helps ensure proper treatment, billing, and documentation of the patient's medical history.

Which Polymyalgia Rheumatica ICD Codes are Billable

Commonly used ICD-10 codes for Polymyalgia Rheumatica (PMR) that are typically billable include:

• M35.3: Polymyalgia rheumatica - Yes
• M35.31: Polymyalgia rheumatica with codes l2y Amylase (HLA-DR4) genotype - Yes
• M35.32: Polymyalgia rheumatica with diffuse pigmented villonodular synovitis - Yes
• M35.39: Other polymyalgia rheumatica - Yes
• M79.0: Rheumatism, unspecified - Yes 
• M79.1: Myalgia - Yes
• M79.2: Neuralgia and neuritis, unspecified - Yes 
• M79.7: Fibromyalgia - Yes 
• M79.9: Soft tissue disorder, unspecified - Yes
• G56.01: Carpal tunnel syndrome, right upper limb - Yes 

Accurate codes are crucial for billing and diagnosis related to Polymyalgia Rheumatica. Proper documentation and adherence to coding guidelines are essential for healthcare providers to receive reimbursement for PMR care.

Clinical Information

• Polymyalgia Rheumatica is an inflammatory disorder primarily affecting the elderly, causing pain and stiffness in the shoulders, neck, and hips.
• Common symptoms include severe muscle pain, morning stiffness, limited range of motion in affected areas, fatigue, and low-grade fever.
• PMR predominantly affects individuals over 50, with a higher incidence in women.
• Patients typically have elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, aiding in diagnosis.
• There's a significant association between PMR and GCA, a condition involving inflammation of the arteries, particularly the temporal arteries.
• PMR can sometimes mimic other conditions like fibromyalgia, rheumatoid arthritis, or osteoarthritis, making accurate diagnosis crucial.
• PMR often shows a rapid and dramatic response to low-dose corticosteroid treatment, which is both diagnostic and therapeutic.
• The goal of treatment is to relieve symptoms and prevent complications. A gradual tapering of corticosteroids over time is common, and long-term follow-up is necessary.
• If left untreated, PMR can lead to joint inflammation, fractures due to falls, and a decreased quality of life.
• Regular clinical assessments and monitoring of inflammatory markers are essential to assess disease activity and adjust treatment accordingly.
• Patients should be educated about the nature of the disease, the importance of treatment adherence, and the potential side effects of corticosteroids.
• Management often involves rheumatologists, primary care physicians, and sometimes, ophthalmologists (for GCA) to provide comprehensive care.

Synonyms Include

• PMR
• Polymyalgia
• PMR Syndrome
• Polymyalgia Rheumatica Syndrome
• Periarticular Rheumatism
• Senior-Onset Rheumatoid Arthritis
• Shoulder-Girdle Syndrome
• Giant Cell Arteritis without Arteritis
• Polymyalgia Rheumatica Arthritis
• Elderly-Onset Rheumatoid Arthritis