As of October 1, 2015, fibromyalgia finally has its own official diagnostic code in the ICD-10-CM codes formally adopted in the U.S.
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 October 1, 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 FM is recognized as a distinct entity with its own code: M79.7 – Fibromyalgia.
Why Is This Important?
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There are numerous potential benefits of a ICD-10-CM code for fibromyalgia, but four in particular quickly 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-CM codes are used by insurance companies, Medicare and Medicaid when making reimbursement decisions. Up until now, some insurance companies have 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 will eliminate one reason sometimes used as a basis for denial and may make disability claims a little easier to win.
- A distinct diagnostic code will improve consistency in fibromyalgia research. Ginevra Liptan, MD noted in her recent 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.”
The Culmination of a Long Journey
Fibromyalgia’s journey to legitimacy has been 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. Now, in 2015, the Centers for Medicare and Medicaid Services and the National Center for Health Statistics have given FM an official diagnostic code.
This completes the trifecta of legitimacy and is a milestone worth celebrating!
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.”