2025 ICD-10-CM code M79
(Valid) Effective Date: N/A Diseases of the musculoskeletal system and connective tissue - Other soft tissue disorders 13 Feed
Other and unspecified soft tissue disorders, not elsewhere classified.
Medical necessity must be established for the use of code M79. The documentation must support the need for medical intervention due to the soft tissue disorder. This might include limitations in function, impacting daily activities, unsuccessful conservative treatments, and persistent symptoms.
Clinicians diagnose these disorders through patient history, physical examination, imaging studies (X-rays, MRI, ultrasound), and sometimes blood tests to evaluate inflammation or autoantibodies. Treatment often involves pain relief and inflammation reduction with analgesics, corticosteroids, or NSAIDs, along with physical therapy to improve range of motion, strength, and flexibility.
In simple words: This code represents a general category for soft tissue problems like muscle or ligament issues that don't have a more specific diagnosis. It's used when the doctor knows there's a problem with the soft tissues, but it doesn't fit into a more specific category.
This code encompasses soft tissue disorders that are not classified under other specific codes within the M00-M99 range. It includes conditions affecting soft tissues such as muscles, tendons, ligaments, fascia, and other connective tissues, excluding those with specific classifications like bursitis, tendinitis, or enthesopathies. It also includes unspecified soft tissue disorders where a more precise diagnosis is not available.
Example 1: A patient presents with persistent pain and stiffness in their right shoulder, but imaging and physical exams do not reveal a specific diagnosis like rotator cuff tear or bursitis. The physician may use M79 to code this unspecified soft tissue disorder., A patient experiences muscle pain and weakness after an injury, but the extent of the injury is unclear. If other diagnoses are ruled out and the condition remains unspecified, M79 may be used., A patient with diagnosed fibromyalgia presents with widespread pain and tenderness. While fibromyalgia itself has specific codes (M79.7), if the documentation only refers to unspecified soft tissue pain and other causes are ruled out, M79 can be applied.
Documentation should include details of the patient's symptoms, location of the pain or discomfort, physical examination findings, results of imaging or laboratory studies, and any other relevant clinical information to support the diagnosis of an unspecified soft tissue disorder.
** Excludes1: psychogenic rheumatism (F45.8) soft tissue pain, psychogenic (F45.41). Excludes2: arthropathic psoriasis (L40.5-), certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), compartment syndrome (traumatic) (T79.A-), 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)
- Specialties:Orthopedics, Rheumatology, Physical Medicine and Rehabilitation, Primary Care
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital, Other Place of Service