ICD-10 Coding for Lower Limb Pain(M79.604, M79.605, G57.90)
Complete ICD-10-CM coding and documentation guide for Lower Limb Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lower Limb Pain
M79.60-M79.67Primary Range
Pain in limb, hand, foot, fingers and toes
This range includes codes for unspecified and specific limb pain, including laterality.
Mononeuropathy of lower limb, unspecified
Used for neuropathic pain in the lower limb when confirmed by diagnostic tests.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M79.604 | Pain in right leg | Use when patient presents with generalized right leg pain without specific underlying condition. |
|
| M79.605 | Pain in left leg | Use when patient presents with generalized left leg pain without specific underlying condition. |
|
| G57.90 | Mononeuropathy of lower limb, unspecified | Use when neuropathic pain is confirmed by diagnostic tests. |
|
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 lower limb pain
Essential facts and insights about Lower Limb Pain
Primary ICD-10-CM Codes for lower limb pain
Decision Criteria
clinical Criteria
- Presence of pain localized to the right leg without specific cause.
Applicable To
- Right leg pain
Excludes
- Pain in right foot (M79.671)
Clinical Validation Requirements
- Documentation of right leg pain without specific etiology
- Absence of trauma or neurological signs
Code-Specific Risks
- Risk of using unspecified code when laterality is documented.
Coding Notes
- Ensure documentation specifies laterality to avoid unspecified code usage.
M79.605 - Pain in left leg
Use when patient presents with generalized left leg pain without specific underlying condition.
Applicable To
- Left leg pain
Excludes
- Pain in left foot (M79.672)
Clinical Validation Requirements
- Documentation of left leg pain without specific etiology
- Absence of trauma or neurological signs
Coding Notes
Ensure documentation specifies laterality to avoid unspecified code usage.
G57.90 - Mononeuropathy of lower limb, unspecified
Use when neuropathic pain is confirmed by diagnostic tests.
Applicable To
- Neuropathic pain in lower limb
Excludes
- Radiculopathy (M54.10-M54.19)
Clinical Validation Requirements
- Nerve conduction studies confirming neuropathy
- Burning or shooting pain descriptors
Coding Notes
Document diagnostic test results to support neuropathy coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Mononeuropathy of lower limb, unspecified
G57.90Differential 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 Lower Limb Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M79.604.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Increases risk of audit for incorrect coding., Financial: Potential loss of reimbursement for chronic pain management.
Mitigation Strategy
Use templates that include chronicity prompts, Regularly review documentation practices
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Increases risk of audit due to non-specific coding., Data Quality: Impacts data accuracy and quality for clinical analysis.
Mitigation Strategy
Always specify laterality in documentation to use specific codes.
Impact
Use of unspecified codes when specific codes are available.
Mitigation Strategy
Implement documentation templates that require laterality and specific pain descriptors.
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 Lower Limb Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lower Limb Pain
Use these documentation templates to ensure complete and accurate documentation for Lower Limb Pain. These templates include all required elements for proper coding and billing.
Lower Limb Pain Assessment
Specialty: Primary CareRequired Elements
- Location and laterality of pain
- Pain characteristics (e.g., burning, stabbing)
- Aggravating and relieving factors
- Neurological findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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