ICD Code M35.3

ICD code M35.3 is polymyalgia rheumatica, an inflammatory disorder causing muscle pain and stiffness, especially in the shoulders and hips, commonly affecting older adults.

1. Age typically over 50 years

2. Bilateral aching and morning stiffness lasting at least 30 minutes in the shoulder and/or pelvic girdle

3. Sudden onset of pain and stiffness in the neck, shoulders, and hips

4. Elevated erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP)

5. Absence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies

6. Rapid response to low-dose corticosteroids

7. No evidence of other inflammatory or infectious diseases that could explain symptoms

Relevant CPT codes that may be used to treat ICD code M35.3 include:

- 99202–99215 (Evaluation and Management services, new or established patient)

- 96372 (Therapeutic, prophylactic, or diagnostic injection)

- 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa)

- 36415 (Collection of venous blood by venipuncture)

- 80050, 80053 (General health panel, comprehensive metabolic panel)

- 85025 (Complete blood count with automated differential)

- 85652 (Erythrocyte sedimentation rate)

- 84443 (Thyroid stimulating hormone assay)

- 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis)

CPT code selection should be based on the specific services rendered for ICD code M35.3.

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