Fibromyalgia finally officially gained its legitimacy in the U.S. four years ago on October 1, 2015. That’s when the ICD-10 code for fibromyalgia was formally adopted. At long last, fibromyalgia patients received the validation they had been seeking for a quarter of a century.
ICD-10-CM, which stands for International Classification of Diseases, 10th Revision, Clinical Modification, is a list of diagnostic codes provided by the Centers for Medicare and Medicaid Services and the National Center for Health Statistics to be used for medical reporting in the U.S. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization.
ICD codes are used by everyone in the healthcare industry, including doctors, insurance companies and government agencies. They are used to identify and classify diagnosed diseases and conditions.
Prior to the adoption of ICD-10, when diagnosing a patient with fibromyalgia, doctors had to use the general code: 729.1 – Myalgia and myositis, unspecified. Any kind of muscle pain or inflammation could be included under that code. But now with the ICD-10 fibromyalgia code, it is recognized as a distinct entity with its own unique code: M79.7 – Fibromyalgia.
Why Is a Fibromyalgia ICD-10 Code Important?
There are numerous potential benefits of a ICD-10 code for fibromyalgia, but four in particular immediately come to mind.
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- The fact that fibromyalgia has its own diagnostic code makes it all but impossible for doctors to continue to insist that it’s not real. The World Health Organization and the U.S. Government have given it their official seal of approval.
- The ICD-10 codes are used by insurance companies, Medicare and Medicaid when making reimbursement decisions. Before there was an ICD-10 code for fibromyalgia, some insurance companies refused to cover treatments for fibromyalgia, insisting it was not a real disease. They can no longer make that claim.
- Although disability claims are not determined solely based on a diagnosis, having fibromyalgia recognized as a legitimate diagnosis eliminated one reason that was sometimes used as a basis for denial.
- A distinct diagnostic code should improve consistency in fibromyalgia research. Ginevra Liptan, MD noted in her 2015 article in the National Pain Report, “The new code will also enable more accurate studies of fibromyalgia treatment outcomes, as the data for many of these observational studies are gathered by tracking diagnosis codes. Without its own diagnoses code, fibromyalgia studies have been hampered by watered down data from the inclusion of patients that did not actually have fibro, but some other illness causing muscle pain.”
ICD-10 Fibromyalgia Code Was the Culmination of a Long Journey
Fibromyalgia’s journey to legitimacy was long and hard-fought. After allowing it to languish in obscurity for many years, one by one, U.S. Government agencies began acknowledging that fibromyalgia is indeed real.
- The FDA led the way in 2007 when it approved the very first drug for the treatment of FM.
- Then in 2012, the Social Security Administration issued a ruling recognizing fibromyalgia as a legitimate impairment.
- Finally, in 2015, the Centers for Medicare and Medicaid Services and the National Center for Health Statistics gave fibromyalgia its own official diagnostic code.
That action completed the trifecta of legitimacy. There is no longer any valid reason for a U.S. doctor to question whether or not fibromyalgia is real.
This article, originally published on October 7, 2015, was updated on September 30, 2019.
Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) in 1997 and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE magazine. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, then worked for eight years as the Chronic Pain Health Guide for The HealthCentral Network before coming to ProHealth. To learn more about Karen, see “Meet Karen Lee Richards.”