ICD Code M94.0

ICD code M94.0 is a classification for Chondrocostal junction syndrome, commonly known as Tietze syndrome. This condition is characterized by inflammation of the cartilage where the ribs attach to the breastbone, leading to localized pain and swelling in the chest area. It is important for healthcare providers to accurately document this condition using the ICD code to ensure proper billing and treatment planning.

1. Localized Pain: Presence of localized pain at the costosternal, costochondral, or costovertebral junctions, typically affecting the upper ribs. The pain is often sharp and may radiate to the arms or shoulders.

2. Swelling: Observable swelling at the affected junction, which is a distinguishing feature. The swelling is usually unilateral and can be tender to touch.

3. Tenderness: Palpable tenderness over the affected costal cartilage, which is exacerbated by physical activity, deep breathing, or coughing.

4. Absence of Systemic Symptoms: Lack of systemic symptoms such as fever, malaise, or weight loss, which helps differentiate it from other conditions like infections or malignancies.

5. Exclusion of Other Conditions: Rule out other potential causes of chest pain and swelling, such as costochondritis, rib fractures, or cardiac conditions, through clinical evaluation and diagnostic testing.

6. Age and Gender Considerations: While it can occur in any age group, it is more commonly diagnosed in younger individuals and may have a slight female predominance.

7. Response to Treatment: Positive response to conservative treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) and rest, which can help confirm the diagnosis.

8. Duration of Symptoms: Symptoms that persist for weeks to months, distinguishing it from acute conditions that resolve more quickly.

By following these diagnostic criteria, healthcare providers can accurately determine when to use the specific ICD code for this condition.

For the ICD code M94.0, which is associated with Chondrocostal junction syndrome [Tietze], the relevant CPT codes that may be applicable for treatment include:

1. 20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia").

2. 20610 - Arthrocentesis, aspiration and/or injection into a major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.

3. 99201-99215 - Evaluation and Management (E/M) codes for office or other outpatient visits, depending on the complexity and time spent with the patient.

4. 97110 - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility.

5. 97140 - Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

These CPT codes are examples of procedures that may be used in the management or treatment of conditions related to the ICD code M94.0. It is important for healthcare providers to select the appropriate CPT code based on the specific services rendered and the clinical scenario.

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