ICD-10 Coding for Hypermobility Syndrome(M35.7, Q79.6)
Complete ICD-10-CM coding and documentation guide for Hypermobility Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypermobility Syndrome
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M35.7 | Hypermobility Syndrome | Use when generalized joint hypermobility is present with chronic pain or instability. |
|
| Q79.6 | Ehlers-Danlos Syndrome | Use when Ehlers-Danlos syndrome is confirmed by criteria. |
|
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 hypermobility
Essential facts and insights about Hypermobility Syndrome
Primary ICD-10-CM Codes for hypermobility
Decision Criteria
clinical Criteria
- Beighton score ≥4/9 with chronic pain
coding Criteria
- Differentiate from Ehlers-Danlos syndrome
Applicable To
- Generalized joint hypermobility with chronic pain
Clinical Validation Requirements
- Beighton score ≥4/9
- Chronic musculoskeletal pain ≥3 months
Code-Specific Risks
- Confusion with Ehlers-Danlos syndrome
- Lack of specific documentation like Beighton score
Coding Notes
- Ensure documentation includes Beighton score and chronicity of symptoms.
Q79.6 - Ehlers-Danlos Syndrome
Use when Ehlers-Danlos syndrome is confirmed by criteria.
Applicable To
- Confirmed Ehlers-Danlos syndrome
Clinical Validation Requirements
- 2017 diagnostic criteria for hEDS
- Systemic manifestations and family history
Coding Notes
Ensure genetic testing or criteria documentation is present.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypermobility Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M35.7.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Potential audit failure., Financial: Claim denials due to insufficient documentation.
Mitigation Strategy
Ensure Beighton score is assessed and recorded., Train staff on documentation standards.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use Z13.89 for screening if no symptoms are present.
Impact
Lack of specific findings like Beighton score can trigger audits.
Mitigation Strategy
Standardize documentation templates to include all necessary criteria.
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 Hypermobility Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypermobility Syndrome
Use these documentation templates to ensure complete and accurate documentation for Hypermobility Syndrome. These templates include all required elements for proper coding and billing.
Chronic joint instability
Specialty: OrthopedicsRequired Elements
- Beighton score
- Joint instability tests
- Chronic pain assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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