ICD Code M79.1

ICD code M79.1 is a classification used to denote myalgia, which refers to muscle pain. This code is utilized by healthcare providers to document and communicate the diagnosis of muscle pain in medical records and billing processes.

1. Muscle Pain: The presence of persistent or recurrent pain in the muscles, which may be localized or widespread.

2. Tenderness: Notable tenderness upon palpation of the affected muscle areas, often without significant swelling or redness.

3. Muscle Stiffness: Experiencing stiffness in the muscles, particularly after periods of rest or upon waking.

4. Fatigue: Generalized fatigue or a feeling of tiredness that is not relieved by rest, often accompanying muscle pain.

5. Functional Impairment: Difficulty in performing daily activities due to muscle pain or discomfort, which may affect mobility or strength.

6. Absence of Other Diagnoses: Ruling out other potential causes of muscle pain, such as inflammatory conditions, infections, or neurological disorders, through clinical evaluation and diagnostic testing.

7. Duration: Symptoms persisting for a significant period, typically more than a few days, warranting further investigation and diagnosis.

8. Patient History: A thorough patient history indicating no recent trauma or injury that could account for the muscle pain, unless the pain persists beyond the expected healing period.

9. Exclusion of Systemic Conditions: Ensuring that the muscle pain is not a symptom of a systemic condition such as fibromyalgia, chronic fatigue syndrome, or other rheumatologic diseases.

10. Response to Treatment: Observing the response to initial treatments such as rest, physical therapy, or analgesics, which may help in confirming the diagnosis if symptoms improve.

For the ICD code M79.1 (Myalgia), the relevant CPT codes that may be applicable for treatment include:

1. 97110 - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility.

2. 97112 - Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception.

3. 97140 - Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction).

4. 99201-99215 - Evaluation and management services, depending on the complexity and time spent with the patient.

5. 20552 - Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

6. 20553 - Injection(s); single or multiple trigger point(s), 3 or more muscles.

These CPT codes are often used in conjunction with the diagnosis of myalgia to ensure appropriate billing and reimbursement for services rendered. Always verify with the latest coding guidelines and payer-specific policies to ensure accurate coding.

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