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v1.0.0
ICD-10 Guide
ICD-10 CodesG71.21

G71.21

Billable

Nemaline myopathy

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

Code Description

ICD-10 G71.21 is a billable code used to indicate a diagnosis of nemaline myopathy.

Key Diagnostic Point:

Nemaline myopathy is a rare congenital myopathy characterized by muscle weakness and the presence of nemaline bodies in muscle fibers. It is caused by mutations in genes that are critical for muscle structure and function, leading to impaired muscle contraction. Patients typically present with hypotonia, muscle weakness, and delayed motor milestones. The severity of symptoms can vary widely, with some individuals experiencing mild weakness and others facing significant disability. Nemaline myopathy can affect any skeletal muscle, but proximal muscles are often more severely impacted. Diagnosis is confirmed through muscle biopsy, which reveals nemaline bodies, and genetic testing can identify specific mutations. Management focuses on supportive care, including physical therapy, respiratory support, and nutritional management, as there is currently no cure for the condition. The prognosis varies, with some individuals leading relatively normal lives while others may have significant limitations.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity among patients
  • Need for precise documentation of muscle biopsy findings
  • Potential overlap with other myopathies and neuromuscular disorders
  • Requirement for genetic testing results for accurate coding

Audit Risk Factors

  • Inadequate documentation of muscle biopsy results
  • Failure to include genetic testing information
  • Misclassification with other myopathies
  • Lack of detailed clinical history

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, muscle biopsy results, and genetic testing outcomes.

Common Clinical Scenarios

Patients presenting with unexplained muscle weakness, hypotonia in infants, or progressive muscle weakness in adults.

Billing Considerations

Ensure comprehensive documentation of muscle strength testing and any associated symptoms.

Genetics

Documentation Requirements

Genetic testing results, family history of neuromuscular disorders, and detailed clinical assessments.

Common Clinical Scenarios

Patients with a family history of congenital myopathies or those with unexplained muscle weakness.

Billing Considerations

Document the specific genetic mutations identified and their implications for treatment.

Coding Guidelines

Inclusion Criteria

Use G71.21 When
  • According to ICD
  • 10 guidelines, G71
  • 21 should be used when a definitive diagnosis of nemaline myopathy is established through clinical, histological, and genetic evidence
  • It is important to document the specific symptoms and findings that support the diagnosis

Exclusion Criteria

Do NOT use G71.21 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

88305CPT Code

Muscle biopsy

Clinical Scenario

Used to confirm diagnosis of nemaline myopathy through histological examination.

Documentation Requirements

Pathology report detailing the presence of nemaline bodies.

Specialty Considerations

Ensure the biopsy is performed by a qualified specialist and results are documented thoroughly.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of rare conditions like nemaline myopathy, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like nemaline myopathy, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. It has also facilitated better tracking of patient outcomes and resource allocation.

Resources

Clinical References

  • •
    Nemaline Myopathy Foundation

Coding & Billing References

  • •
    Nemaline Myopathy Foundation

Frequently Asked Questions

What are the common symptoms of nemaline myopathy?

Common symptoms include muscle weakness, hypotonia, delayed motor milestones, and respiratory difficulties. The severity of symptoms can vary widely among individuals.

How is nemaline myopathy diagnosed?

Diagnosis is typically made through a combination of clinical evaluation, muscle biopsy showing nemaline bodies, and genetic testing to identify specific mutations.