Fibromyalgia

This code identifies a chronic, widespread musculoskeletal pain disorder characterized by tenderness in specific areas, fatigue, sleep disturbances, and cognitive difficulties. It represents a syndrome of generalized pain and heightened pain response to pressure.

Assign this code when documentation clearly indicates a diagnosis of fibromyalgia, often supported by a history of widespread pain lasting at least three months and tenderness in at least 11 of 18 specific tender points, or based on the 2010 or 2016 diagnostic criteria. This code is appropriate for both initial and subsequent encounters related to the management of this condition.

• Do not code symptoms separately when a definitive diagnosis of fibromyalgia is established.
• Ensure documentation specifies "fibromyalgia" rather than just generalized pain or chronic fatigue.
• Consider sequencing this code as the primary diagnosis when it is the main reason for the encounter.