ICD-10 Coding for Fatigue(R53.0, R53.1, R53.2, R53.81, R53.82, R53.83, G93.32)
Complete ICD-10-CM coding and documentation guide for Fatigue. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fatigue
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R53.0 | Neoplastic (malignant) related fatigue | Use when fatigue is directly related to a neoplastic condition. |
|
| R53.1 | Weakness | Use when weakness is the primary symptom, not fatigue. |
|
| R53.2 | Functional quadriplegia | Use for quadriplegia due to functional, not paralytic, causes. |
|
| R53.81 | Other malaise | Use when malaise is the primary symptom, not fatigue. |
|
| R53.82 | Chronic fatigue, unspecified | Use when chronic fatigue is present but does not meet ME/CFS criteria. |
|
| R53.83 | Other fatigue | Use when fatigue is present but not chronic or linked to a specific condition. |
|
| G93.32 | Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) | Use when ME/CFS criteria are met. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for chronic fatigue syndrome
Essential facts and insights about Fatigue
Primary ICD-10-CM Codes for fatigue
Decision Criteria
clinical Criteria
- Fatigue is directly related to a diagnosed neoplasm.
Applicable To
- Fatigue due to cancer
Excludes
- Fatigue due to other conditions
Clinical Validation Requirements
- Documentation of cancer diagnosis
- Fatigue directly related to cancer
Code-Specific Risks
- Incorrectly used as primary code when cancer should be primary
Coding Notes
- Ensure the neoplasm is coded as the primary condition.
R53.1 - Weakness
Use when weakness is the primary symptom, not fatigue.
Applicable To
- Generalized weakness
Excludes
- Fatigue (R53.83)
Clinical Validation Requirements
- Documentation of generalized weakness
- Exclusion of fatigue as primary symptom
Coding Notes
Differentiate between weakness and fatigue.
R53.2 - Functional quadriplegia
Use for quadriplegia due to functional, not paralytic, causes.
Applicable To
- Quadriplegia due to functional causes
Excludes
- Paralytic quadriplegia
Clinical Validation Requirements
- Documentation of functional cause
- Exclusion of paralytic causes
Coding Notes
Ensure functional cause is documented.
R53.81 - Other malaise
Use when malaise is the primary symptom, not fatigue.
Applicable To
- General malaise
Excludes
- Fatigue (R53.83)
Clinical Validation Requirements
- Documentation of malaise
- Exclusion of fatigue as primary symptom
Coding Notes
Differentiate between malaise and fatigue.
R53.82 - Chronic fatigue, unspecified
Use when chronic fatigue is present but does not meet ME/CFS criteria.
Applicable To
- Chronic fatigue not meeting ME/CFS criteria
Excludes
- Chronic fatigue syndrome (G93.32)
Clinical Validation Requirements
- Documentation of fatigue lasting more than 6 months
- Exclusion of ME/CFS criteria
Coding Notes
Ensure ME/CFS criteria are not met before using this code.
R53.83 - Other fatigue
Use when fatigue is present but not chronic or linked to a specific condition.
Applicable To
- Fatigue not otherwise specified
Excludes
- Chronic fatigue syndrome (G93.32)
Clinical Validation Requirements
- Documentation of fatigue
- Exclusion of specific causes like anemia or thyroid disorders
Coding Notes
Ensure other causes are ruled out.
G93.32 - Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Use when ME/CFS criteria are met.
Applicable To
- Chronic fatigue syndrome
Excludes
- Chronic fatigue, unspecified (R53.82)
Clinical Validation Requirements
- Documentation of ME/CFS per CDC criteria
- Presence of post-exertional malaise and cognitive impairment
Coding Notes
Ensure full documentation of ME/CFS criteria.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fatigue to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R53.0.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Always include duration in clinical notes., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation of ME/CFS prevalence.
Mitigation Strategy
Ensure ME/CFS criteria are met and use G93.32 instead.
Impact
Reimbursement: May affect DRG assignment and reimbursement., Compliance: Non-compliance with sequencing rules., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Identify and code the underlying condition first.
Impact
Using R53.82 when ME/CFS criteria are met.
Mitigation Strategy
Ensure documentation supports ME/CFS criteria before coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Fatigue, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fatigue
Use these documentation templates to ensure complete and accurate documentation for Fatigue. These templates include all required elements for proper coding and billing.
Chronic fatigue evaluation
Specialty: Primary CareRequired Elements
- Duration of fatigue
- Impact on daily activities
- Associated symptoms
- Ruling out other conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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