Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term disabling and complex condition. This chronic, multi-system disease affects many body systems. Millions of people worldwide are affected by this condition. According to an Institute of Medicine (IOM) report, an estimated 836,000 to 2.5 million Americans suffer from ME/CFS. However, most of them have not been diagnosed. When a patient is diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), claims are submitted by billing them with the relevant medical codes. Providers often consider obtaining medical billing services from professional medical billing companies to get the task done.
Severe fatigue is a common symptom of this condition. Other symptoms include dizziness, problems with thinking and concentrating, and pain. Patients may also experience cognitive impairment, orthostatic intolerance, flu-like symptoms, fast or irregular heartbeats and sensory sensitivity.
Coding for this condition has changed with effect from October 1, 2022. With the recent update, providers can now select G93.32 as a diagnostic code for ME/CFS. The update also directs coders to use the code U09.9 for post-COVID condition when appropriate, making it clearer when ME/CFS occurs following SARS CoV-2 infection. The code applies to “myalgic encephalomyelitis/chronic fatigue syndrome,” “chronic fatigue syndrome,” and “myalgic encephalomyelitis.” According to CDC, the new code will make it easier for healthcare providers to bill and get reimbursed for ME/CFS-related care as it enables documentation of ME/CFS in the medical records. The new release also modifies the description of tabular listing code G93.3 to encompass both viral and non-viral causes.
Coding Issues before Update
An AAPC article explains that before the 2023 update to ICD-10-CM, there was no specific code for myalgic encephalomyelitis/chronic fatigue syndrome. Coders have used the code R53.82 Chronic fatigue, unspecified, which includes chronic fatigue syndrome. This code brought much confusion to healthcare providers, patients, and researchers because ME/CFS was grouped with all types of unspecified chronic fatigue. Coders faced many issues –
- Lack of specificity of codes made it difficult to track ME/CFS separately from the symptom of chronic fatigue.
- Some coders also used ICD-10-CM code G93.3 Postviral fatigue syndrome (PVFS), which includes benign myalgic encephalomyelitis. Under this classification, however, some doctors declined to diagnose ME when viral illness was not proven, even though ME can be triggered by both viral and non-viral precipitants.
- Another issue with using this code is that ME and ME/CFS definitions specify that symptoms should persist for at least six months, while PVFS has no such minimum time requirement.
Code Revision
As a remedy to the situation the code description for G93.3 is revised.
The AAPC article explains the revisions implemented as –
- Under A85 Other viral encephalitis, not elsewhere classified, the Excludes1 is revised from “benign myalgic encephalomyelitis (G93.3)” to “myalgic encephalomyelitis (G93.32).” This same revision was made to the Excludes2 note under G04 Encephalitis, myelitis and encephalomyelitis.
- Under G93 Other disorders of brain, G93.3 is revised to “Postviral and related fatigue syndromes,” the inclusion term “benign myalgic encephalomyelitis” is deleted, and “neurasthenia (F48.8)” is added to the Excludes1 note.
- New codes include G93.31 Postviral fatigue syndrome, G93.32 Myalgic encephalomyelitis/chronic fatigue syndrome, which includes chronic fatigue syndrome, ME/CFS, and ME, and G93.39 Other post infection and related fatigue syndromes.
- Under R53.82, “chronic fatigue syndrome NOS” is deleted as an inclusion term; G93.32 and G93.39 are added to the Excludes1 note; and the code for postviral fatigue syndrome is revised in the Excludes1 note to the new expanded code, G93.31.
- Revisions to the ICD-10-CM Index were made to reflect these changes. Additions include post bacterial fatigue and post infectious fatigue, coded with G93.39. Also added to the Index is SEID (systemic exertion intolerance disease), coded with G93.32, although you won’t find SEID in the Tabular List.
It is important for healthcare providers, front office staff and pain management medical billing service providers to be aware of these new and revised codes for ME and CFS to help improve data tracking and ensure appropriate care for patients with ME/CFS.
Since joining our RCM Division in October 2021, Loralee, who is HIT Certified (Health Information Technology/Health Information Management), brings her extensive expertise in medical coding and Health Information Management practices to OSI.