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v1.0.0
ICD-10 Guide
ICD-10 CodesG72.49

G72.49

Billable

Other inflammatory and immune myopathies, not elsewhere classified

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

Code Description

ICD-10 G72.49 is a billable code used to indicate a diagnosis of other inflammatory and immune myopathies, not elsewhere classified.

Key Diagnostic Point:

G72.49 encompasses a variety of inflammatory and immune-mediated myopathies that do not fit into more specific categories. These conditions can lead to muscle weakness and inflammation, affecting the skeletal muscles. Myasthenia gravis, a neuromuscular junction disorder, is characterized by weakness and rapid fatigue of voluntary muscles due to an autoimmune attack on acetylcholine receptors. Muscular dystrophies, while primarily genetic, can have inflammatory components that complicate their presentation. Other myopathies may arise from autoimmune diseases, infections, or toxic exposures, leading to muscle inflammation and damage. Accurate diagnosis often requires a combination of clinical evaluation, laboratory tests, and imaging studies. Treatment typically involves immunosuppressive therapies, physical therapy, and supportive care, tailored to the specific underlying cause of the myopathy. Given the complexity of these conditions, a multidisciplinary approach is often necessary for optimal patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of underlying causes and presentations
  • Overlap with other myopathy codes
  • Need for comprehensive documentation
  • Potential for misdiagnosis with similar conditions

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the underlying cause of myopathy
  • Misclassification of myopathy types
  • Lack of supporting lab results or imaging studies

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed clinical history, neurological examination findings, and results from electromyography (EMG) and muscle biopsy.

Common Clinical Scenarios

Patients presenting with unexplained muscle weakness, fatigue, or pain.

Billing Considerations

Ensure clear documentation of the diagnostic process and any differential diagnoses considered.

Rheumatology

Documentation Requirements

Comprehensive assessment of autoimmune markers, muscle strength testing, and patient history regarding systemic symptoms.

Common Clinical Scenarios

Patients with suspected inflammatory myopathy associated with systemic autoimmune diseases.

Billing Considerations

Document any co-existing autoimmune conditions that may influence treatment.

Coding Guidelines

Inclusion Criteria

Use G72.49 When
  • According to ICD
  • 10 guidelines, G72
  • 49 should be used when the myopathy is inflammatory or immune
  • mediated and does not fit into other specified categories
  • Coders should ensure that the documentation supports the diagnosis and that all relevant clinical information is included

Exclusion Criteria

Do NOT use G72.49 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95873CPT Code

Electromyography (EMG)

Clinical Scenario

Used to evaluate muscle function in suspected myopathy cases.

Documentation Requirements

Document the clinical rationale for EMG and findings.

Specialty Considerations

Neurology specialists should ensure comprehensive reporting of EMG results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of myopathies, including G72.49, which captures a broader range of inflammatory and immune myopathies that were previously less defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of myopathies, including G72.49, which captures a broader range of inflammatory and immune myopathies that were previously less defined in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of myopathies, including G72.49, which captures a broader range of inflammatory and immune myopathies that were previously less defined in ICD-9.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What conditions are included under G72.49?

G72.49 includes various inflammatory and immune myopathies that do not fall under more specific categories, such as polymyositis or dermatomyositis. It is important to document the specific type of myopathy and its underlying cause.