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ICD-10 Guide
ICD-10 CodesG71.20

G71.20

Billable

Congenital myopathy, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G71.20 is a billable code used to indicate a diagnosis of congenital myopathy, unspecified.

Key Diagnostic Point:

Congenital myopathy refers to a group of inherited muscle disorders that are present at birth or develop in early childhood. These conditions are characterized by muscle weakness and hypotonia, which can lead to significant functional impairment. The term 'unspecified' indicates that the specific type of congenital myopathy has not been determined. Congenital myopathies can result from various genetic mutations affecting muscle structure and function, including defects in muscle proteins. Unlike muscular dystrophies, which are progressive and often involve muscle degeneration, congenital myopathies may present with static or slowly progressive weakness. Symptoms can vary widely, including difficulty with motor skills, respiratory issues, and feeding difficulties. Diagnosis typically involves clinical evaluation, genetic testing, and muscle biopsy. Management focuses on supportive care, physical therapy, and addressing specific symptoms, as there is currently no cure for these conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Need for genetic testing and interpretation of results
  • Differentiation from other neuromuscular disorders
  • Documentation of specific symptoms and functional limitations

Audit Risk Factors

  • Insufficient documentation of clinical findings
  • Lack of genetic testing results in the medical record
  • Inconsistent coding of related conditions
  • Failure to document the impact on daily functioning

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, genetic test results, and treatment plans.

Common Clinical Scenarios

Evaluation of infants with hypotonia, muscle weakness, or delayed motor milestones.

Billing Considerations

Ensure comprehensive documentation of neurological assessments and any referrals to genetic counseling.

Pediatrics

Documentation Requirements

Growth and development assessments, family history of neuromuscular disorders, and multidisciplinary care notes.

Common Clinical Scenarios

Management of congenital myopathy in pediatric patients, including feeding difficulties and physical therapy needs.

Billing Considerations

Documenting the impact of the condition on developmental milestones and family support resources.

Coding Guidelines

Inclusion Criteria

Use G71.20 When
  • According to ICD
  • 10 coding guidelines, G71
  • 20 should be used when the specific type of congenital myopathy is not documented
  • Coders should ensure that the diagnosis is supported by clinical findings and that the unspecified nature is justified

Exclusion Criteria

Do NOT use G71.20 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

83036CPT Code

Genetic testing for myopathy

Clinical Scenario

When genetic testing is performed to confirm the diagnosis of congenital myopathy.

Documentation Requirements

Document the reason for testing, results, and how they impact management.

Specialty Considerations

Neurology specialists should ensure that genetic counseling is offered to families.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital myopathies, improving the accuracy of data collection and reimbursement. G71.20 serves as a catch-all for unspecified cases, but coders are encouraged to seek specificity when possible.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital myopathies, improving the accuracy of data collection and reimbursement. G71.20 serves as a catch-all for unspecified cases, but coders are encouraged to seek specificity when possible.

Reimbursement & Billing Impact

reimbursement. G71.20 serves as a catch-all for unspecified cases, but coders are encouraged to seek specificity when possible.

Resources

Clinical References

  • •
    American Academy of Neurology
  • •
    Muscular Dystrophy Association

Coding & Billing References

  • •
    American Academy of Neurology
  • •
    Muscular Dystrophy Association

Frequently Asked Questions

What is the difference between congenital myopathy and muscular dystrophy?

Congenital myopathy refers to a group of muscle disorders present at birth, characterized by muscle weakness and hypotonia, while muscular dystrophies are progressive disorders that lead to muscle degeneration over time. Congenital myopathies may have a static or slowly progressive course, whereas muscular dystrophies typically worsen over time.