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The Official Fibromyalgia ICD-10 Diagnostic Code

Commemorating a momentous event for people with fibromyalgia
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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.

  • 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, 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.”

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13 thoughts on “The Official Fibromyalgia ICD-10 Diagnostic Code”

  1. turner61 says:

    my name is karen i am 54 years old i was diagnosed 10 years ago and have always thought that because people have not herd about it that they have thought it’s real.
    this does not go for my family as they have been a big help .
    i do know a few people who have it now so people are coming around about it and that it does exist .
    i find i have good days and very bad day but the best thing i have found is to just try and get on with it and keep active. for me cycling really does help and having an electric bike is a big help .
    i will continue to exercise to keep fit and my 8 grandchildren keep me busy.
    i know there are a lot out there that have passed this stage and find it hard but maybe now that it has an offical diagnosis people will understand more .

  2. BlueeyesIIII says:

    At present, I’ve tried so many over the counter medications and finally after being diagnosed and treated at both Swedish Hospital and in Spokane, Wa., I am on Gabapentin and an over the counter medicated spray that I will NOT be without (icy hot medicated spray). I would enjoy any input from others. e-mail: Sheila

    Thanks !!

  3. Vip says:

    Hi, I have ME/cfs and Fibromyalgia also a long list of other recognised malfunctions as the body is breaking down. Personal research into nutrients and supplements have been the only help I have received. It is slow but I have made progress and my body is slowly improving.

    Recently I researched electrolytes. I discovered Dr Sircus website in the USA and his focus on Magnesium. I have purchased Magnesium Chloride crystals here in the UK and have put 2-3 cup fulls into a warm bath and soaked for half an hour or so.

    Not only does the body absorb the magnesium and this increases the magnesium in the body, it naturally alkalises the body, and helps with sleep, these are some of the benefits.

    If you research into the symptoms relating to electrolyte deficiencies there is a very high correlation with Fibromyalgia.

    This is one of the steps that is helping me. It might help you but do undertake the research and see if it might be of help to you.
    All the best.
    Vi p

  4. loopeyange says:

    hi, I’m from the UK too, and also have Fibro and ME. I cannot get into a bath because my mobility is restricted, but the thing you mention about electrolytes makes a lot of sense. I’ll have to look into it.

  5. Susanrad says:

    My story is 3.5 years long, but I’ll give the nutshell version. I’m a female, 53 on 10/31. My whole life up until then, I was very active, softball, kayaking, hiking.. I was a Registered Dental Assistant for 25 years. April of 2012, I began to wake up nauseated and when I pushed myself to get to work, I was so sick. By 7/2012, I couldn’t work. I was just too sick.

    As of today, I have had many blood work ups, upper and lower GI tests, CT Scans, head, chest & abdomen. I have Kaiser. I have felt like my very young Dr. Is more bothered by me than wanting to help me. Every time I had test done, I had to ask for them. He made it sound like, ok, but I don’t think it’s necessary. I asked to see a Rheumatologist, she tested for Lupus, but said it came back negative and said I had Fibromyalgia and sent me back to my GP.

    I have many of the other symptoms as well, fatigue, fog, numbness and tingling in my hands, aches, pains, but honestly, it’s the daily nausea that is the most debilitating symptom for me. I’m not on any western medicine. After 1 year, Zofran & Phenergan (?) stopped working.

    I am fighting to get my SSDI, I have been denied and have had no income for 3.5 years. It’s been rough to say the least. It’s been financially difficult for my husband. I don’t know what I would have done if I had been single, as I was less than one year prior to getting sick.

    I hope that with this new code, it will help all of us get the benefit that we earned without having to wait SO long!

    1. Furlow says:

      Finally it took long enough!

    2. andeep says:

      I have switched only in the last month to a gluten-free diet and am just now feeling some positive effects. Bloating, gas, nausea, intestinal tract issues have been reported as part of IBS which is now found to be an issue for many fibro patients as well. It´s a hard switch at first, you have to read up on it and get the facts. I bought a book for gluten-free recipes and auto-immune diseases off amazon. But mostly I am reading from legit sites online about it. hope you find a way to resolve this. kind regards, andeep

    3. whyme2113 says:

      Hi i went thr Morgan&Morgan 3 months later i was approved and had my check but i dident know i had fm yet i put down crohn’s disease and anxiety dont know if that helps and you dont pay then unless you win your case i hope the best for you 🙂

    4. LoneRenegade says:

      I have had fibromyalgia for more than five years. My healthcare provider has been Kaiser Permanente for the last decade. None of the “doctors” I have seen at Kaiser beleaves that fibromyalgia exists. They all tell me that I am eather depressed or phychotic. They insist on treating me for depression or psychosis and ignore the terrable pain I am suffering from. My current primary care physison, Michael Christson, refered me to Kaiser’s pain specilist, “Doctor” Gerrick Amgott-Kwan. Angott-Kwan is the head of chronic pain program and presides over the Kaiser Pain Clinic in Oakland, California. When I met with him, the first words out of his mouth were, “Fibromyalgia is a made up disease where doctors who can’t diagnose their patients put their patients”. Those are his exact words. I remember them clearly. I repeated this to one of coworkers who could clearly see that I was in pain. My coworker informed me of the ProHealth website and encouraged me to get on the computer and search the web. Now that I have found ProHealth and read what is posted regarding fibromyalgia, there is light at the end of the tunnel. Finally, I can find information which will assist me in dealing with this terrable pain.

    5. LoneRenegade says:

      Kaiser will not help you. I have been through many Kaiser doctors. They all believe fibromyalgia is the result of depression or a psychotic disorder. Most will tell you that it is a fabricated desease and that you are faking your symptons. Many of the Kaiser doctors actually did things to me which made my suffering worse. Kaiser is basically corporate medicine. They may tell you thath their main concern is for your health and wellbeing but the truth is that their only concern is collecting your monthly premium and holding on to all of it. It appears their corporate policy is to not acknowledge fibromyalgia. This is probably a cost saving measure. You need to seek help outside of Kaiser.

    6. FAN says:

      Excellent article – thanks Karen! I guess fibromyalgia is not “all in your head” after all. I started a support group for people with fibromyalgia, chronic fatigue syndrome/ME 18 years ago come January 23. Our support group grew into the nonprofit organization, Fibromyalgia Coalition International. I wish FCI had a dollar for every time someone in our group has been told “It’s all in your head.” We could help a lot more people with fibro and related conditions.

  6. andeep says:

    I was diagnosed after several years of crazy pain and tiredness only a few weeks ago. I live in Sweden and wonder if we will follow suit or is this limited tothe USA? Anyone got an idea? Thank, Andrea

  7. RebekahJones says:

    I was diagnosed in 1988. I’ve been part of the long battle to fight for recognition. Finally!

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