ICD-10 Coding for Statin Intolerance(Z79.899, Z91.130, G72.0)
Complete ICD-10-CM coding and documentation guide for Statin Intolerance. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Statin Intolerance
Z79.899-Z91.130Primary Range
Codes for drug intolerance and underdosing due to side effects
These codes are used to document intolerance to statins and related management decisions.
Codes for drug-induced myopathy and myalgia
These codes describe specific muscle-related symptoms associated with statin use.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z79.899 | Other long term (current) drug therapy | Use when documenting chronic intolerance to statins requiring alternative therapies. |
|
| Z91.130 | Patient's intentional underdosing of medication regimen due to side effects | Use when patient intentionally reduces statin dosage due to side effects. |
|
| G72.0 | Drug-induced myopathy | Use when myopathy is confirmed by objective testing. |
|
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 statin intolerance
Essential facts and insights about Statin Intolerance
Primary ICD-10-CM Codes for statin intolerance
Decision Criteria
clinical Criteria
- Patient has documented intolerance to multiple statins.
Applicable To
- Long-term use of medication for chronic conditions
Excludes
- Z91.130 (Underdosing due to side effects)
Clinical Validation Requirements
- Documented intolerance to at least two statins
- Resolution of symptoms upon discontinuation
Code-Specific Risks
- Risk of incorrect use without documenting specific statin intolerance
Coding Notes
- Ensure documentation clearly links statin use to symptoms.
Z91.130 - Patient's intentional underdosing of medication regimen due to side effects
Use when patient intentionally reduces statin dosage due to side effects.
Applicable To
- Underdosing due to adverse effects
Excludes
- Z79.899 (Long-term drug therapy)
Clinical Validation Requirements
- Patient-reported dose reduction
- Provider acknowledgment of underdosing
Coding Notes
Document patient decision and provider discussion.
G72.0 - Drug-induced myopathy
Use when myopathy is confirmed by objective testing.
Applicable To
- Myopathy due to drugs
Excludes
- M79.10 (Myalgia)
Clinical Validation Requirements
- Objective evidence such as EMG or biopsy
- Rechallenge documentation
Coding Notes
Ensure objective evidence is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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 Statin Intolerance to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z79.899.
Impact
Clinical: Inaccurate assessment of statin intolerance., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure rechallenge results are documented., Include specific statin names and dosages.
Impact
Reimbursement: May lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Ensure documentation explicitly states statin intolerance.
Impact
Inadequate documentation may lead to audit findings.
Mitigation Strategy
Ensure comprehensive documentation of symptom onset, resolution, and rechallenge.
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 Statin Intolerance, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Statin Intolerance
Use these documentation templates to ensure complete and accurate documentation for Statin Intolerance. These templates include all required elements for proper coding and billing.
Patient with statin-induced myalgia
Specialty: CardiologyRequired Elements
- Problem List
- Medication History
- Symptom Onset
- Rechallenge Results
- Lab Results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Statin Intolerance? Ask your questions below.