Fibromyalgia finally has its own official diagnostic code in ICD-10-CM formally adopted in USICD-10-CM, which means International Classification of Diseases, 10 th Revision, Clinical Modification, is a list of codes diagnostic provided by the Centers for Medicare and Medicaid Services and the National Center for Health Statistics to be used for medical reports in the United States. ICD-10-CM is based on ICD-10, the statistical classification of diseases published by the World Health Organization.
ICD codes are used by all actors in the health sector, including doctors, insurance companies and government agencies. They are used to identify and classify diagnosed diseases and conditions.
Before October 1, to diagnose a patient with fibromyalgia, physicians had to use the general code 729.1 – Myalgia and myositis, unspecified. Any type of muscle pain or inflammation could be included in this code. But now, FM is recognized as a separate entity with its own code: M79.7 – Fibromyalgia.
Why is it important?
An ICD-10-CM code for fibromyalgia has many potential benefits, but four in particular come quickly to mind.
- The fact that fibromyalgia has its own diagnostic code prevents doctors from continuing to insist that it is not real. The World Health Organization and the United States Government officially gave him their approval.
- ICD-10-CM codes are used by insurance companies, Medicare and Medicaid to make their reimbursement decisions. So far, some insurance companies have refused to cover treatments for fibromyalgia, insisting that it was not a real disease. They can no longer make this claim.
- Although disability claims are not determined solely on the basis of a diagnosis, recognizing fibromyalgia as a legitimate diagnosis will eliminate one of the reasons sometimes cited as a ground for refusal and may make it easier to obtain disability claims.
- A separate diagnostic code will improve the consistency of fibromyalgia research. Ginevra Liptan, MD, noted in her recent article in the National Pain Report : “The new code will also allow more accurate study of the results of fibromyalgia treatment, as data from many of these observational studies are collected by tracking diagnostic codes. Without its own diagnostic code, fibromyalgia studies have been hampered by the dilution of data on the inclusion of patients with no real fibro, but another disease causing muscle pain. “
The culmination of a long journey
The journey from fibromyalgia to legitimacy has been long and hard-fought. After letting it languish in the dark for several years, one by one, US government agencies began to recognize that fibromyalgia was real. The FDA led the way in 2007 by approving the first-ever drug for the treatment of FM. Then, in 2012, the Social Security Administration issued a ruling recognizing fibromyalgia as a legitimate disability. Today, in 2015, the Centers for Medicare and Medicaid Services and the National Center for Health Statistics gave FM an official diagnostic code.
This completes the tripta of legitimacy and is a milestone to celebrate!
Karen Lee Richards is the editor-in-chief of ProHealth. As a fibromyalgia patient, she co-founded the non-profit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She has also been editor-in-chief of Fibromyalgia AWARE , the first ever glossy color magazine devoted to FM and other invisible diseases. After leaving NFA, Karen was a guide to Fibromyalgia and Chronic Fatigue Syndrome for About.com, a New York Times company , then HealthCentral’s Chronic Pain Health Guide.