2025 ICD-10-CM code G72.4

Inflammatory and immune myopathies not classified elsewhere. This encompasses muscle disorders caused by inflammation or an abnormal immune response.

Use G72.4 when the inflammatory myopathy doesn't fit the criteria for other specific myopathies like polymyositis or dermatomyositis. Ensure proper documentation supports the diagnosis and excludes other conditions.

Medical necessity is established by the presence of signs, symptoms, and diagnostic findings consistent with an inflammatory myopathy not otherwise specified. The documentation should clearly demonstrate the impact of the condition on the patient's function and justify the need for treatment and management.

Providers diagnose the condition based on medical history, signs and symptoms, and thorough physical and neurological examination. Diagnostic studies include blood testing to check for electrolyte imbalance, creatine kinase (CK) levels, muscle biopsy, EMG and NCV of nerves and muscles, and renal function test.

In simple words: This code represents a group of muscle diseases caused by inflammation or the body's immune system attacking its own muscles. Symptoms vary but can include muscle weakness, pain, fatigue, and difficulty with movements like walking or lifting.

Inflammatory and immune myopathies, not elsewhere classified, refers to muscle disorders due to inflammation or an abnormal immune response not represented by another code. These myopathies may be due to bacteria, viruses, allergy, injury or an autoimmune response.

Example 1: A 50-year-old female presents with progressive muscle weakness in her hips and shoulders, making it difficult to climb stairs and lift objects. After a thorough examination and diagnostic testing, including a muscle biopsy, she is diagnosed with an inflammatory myopathy not fitting the criteria for polymyositis or dermatomyositis, thus coded as G72.4., A child experiences rapid-onset muscle weakness and pain, accompanied by fever. Tests reveal inflammation in the muscles, and other potential causes are ruled out. The diagnosis is an inflammatory myopathy not otherwise specified, hence G72.4., A patient with a history of autoimmune disease develops muscle weakness and difficulty swallowing. Diagnostic tests, including EMG and blood work, confirm the presence of an inflammatory process affecting the muscles, which does not fall under specific myositis categories, making G72.4 the appropriate code.

Documentation should include medical history, physical and neurological examination findings, results of blood tests (including CK levels and electrolyte panels), EMG, NCV, muscle biopsy (if performed), and any other relevant diagnostic studies. The documentation must support the diagnosis of inflammatory myopathy and exclude other specific types of myositis.

** Excludes1: arthrogryposis multiplex congenita (Q74.3), dermatopolymyositis (M33.-), ischemic infarction of muscle (M62.2-), myositis (M60.-), polymyositis (M33.2-).Excludes2: certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), complications of pregnancy, childbirth, and the puerperium (O00-O9A), congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99), endocrine, nutritional and metabolic diseases (E00-E88), injury, poisoning and certain other consequences of external causes (S00-T88), neoplasms (C00-D49), symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94).

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