What You Need to Know About the ICD-10 Code for Generalized Weakness

Treating patients is hard work, and correct ICD-10 coding can be just as difficult — and just as essential. That’s why we’re helping you make sense of some of the more commonly asked about ICD-10 codes and when you should use them in your practice—and when you shouldn’t. In this post, we’re looking at coding for patients with generalized weakness, including the generalized weakness ICD-10 code you should use. 

How do I code for generalized weakness? 

For patients experiencing muscle weakness that isn’t specified, you can use the ICD-10 code for generalized weakness M62.81,  which is described in this resource as “a disorder characterized by a reduction in the strength of muscles in multiple anatomic sites” or “a reduction in the strength of muscles in multiple anatomic sites.”   

Are there any exclusions with M62.81? 

Yes, there is a Type 1 exclusion for M62.84, muscle weakness in sarcopenia, as well as a Type 2 exclusion for M79.81, nontraumatic hematoma of muscle. Additionally, the M62 family of codes has Type 1 exclusions for:

• alcoholic myopathy (G72.1)
• cramp and spasm (R25.2)
• drug-induced myopathy (G72.0)
• myalgia (M79.1-)
• stiff-man syndrome (G25.82)  

What’s the difference between ICD-10 code R53.1, Weakness, and M62.81, Muscle weakness (generalized)?

Unlike the ICD-10 code for generalized weakness M62.81, R53.1 is associated with: 

• weakness and diminished or absent energy and strength;
• debility, or lack or loss of strength and energy;
• physical weakness, lack of strength and vitality, or a lack of concentration;
• lack of physical or mental strength;
• liability to failure under pressure or stress or strain;
• weakness; and/or
• lack of energy and strength.

When should I use M62.81 as opposed to another code? 

As we mentioned at the top, specificity is the rule in ICD-10, so if a more specific code exists that accurately captures your diagnosis, you should use that one instead. However, if you believe that none of the more specific options fit your diagnosis, then stick with M62.81. 

As we wrote in this ICD-10 FAQ, 

“To code for weakness in a specific area, use the appropriate atrophy code (you’ll find many of these codes in the M62.5 code family). Additionally, keep in mind that the coding guidelines encourage you to code first for the underlying cause of the weakness, rather than the weakness itself. If you are able to do that, you can include the atrophy codes as secondary.”

Will my claim be denied if I use M62.81?  

Because M62.81 is so broad, there is the risk of a claim being denied if you’re coding for generalized weakness rather than a more specific condition. Like many other billing issues these days, your fortunes may depend upon the payer you’re dealing with and your documentation’s ability to substantiate your coding.  

What about weakness in patients with COVID?

According to CMS, If you’re treating patients who have contracted COVID and are dealing with weakness as a result of that, you would use U09.9 as a secondary code along with the code for the specific condition related to COVID. We should note that this code is to be used for post-COVID conditions, and not for conditions associated with an ongoing COVID infection. For a current COVID infection, you would use code U07.1, and instances of a current COVID infection along with symptoms from a prior infection would require both U09.9 and U07.1.   

When should I use ICD-10 code R54?

According to this resource, code R54 applies to age-related physical debility, including: 

• Frailty,
• Old age,
• Senescence,
• Senile asthenia, and
• Senile debility.

Code R54 has a set of Type 1 exclusions, including: 

• age-related cognitive decline (R41.81)
• sarcopenia (M62.84)
• senile psychosis (F03)
• senility NOS (R41.81)

What is sarcopenia (M62.84)?

You might be wondering how the ICD-10 code for sarcopenia differs from the ICD-10 code for generalized weakness. As the Cleveland Clinic outlines in this blog, sarcopenia is “the gradual loss of muscle mass, strength, and function” due to aging. While everyone loses muscle mass beginning in their forties, and more so in their sixties and beyond, patients with sarcopenia lose muscle mass faster than normal. The most common symptoms of sarcopenia are: 

• Muscle weakness,
• Loss of stamina,
• Difficulty performing daily activities,
• Walking slowly,
• Trouble climbing stairs,
• Poor balance and falls, and
• Decrease in muscle size.

If you’ve diagnosed a patient with sarcopenia, you would first want to code the underlying disease before coding M62.84. Some of the underlying diseases are:

• disorders of myoneural junction and muscle disease in diseases classified elsewhere (G73.-)
• other and unspecified myopathies (G72.-)
• primary disorders of muscles (G71.-)

The M62.84 code has Type 1 exclusions for alcoholic myopathy (G72.1), cramp and spasm (R25.2), drug-induced myopathy (G72.0), myalgia (M79.1-), and stiff-man syndrome (G25.82), and a Type 2 exclusion for nontraumatic hematoma of muscle (M79.81).

Learn more about ICD-10-CM coding.

Hopefully, you’re now a lot more informed about the ICD-10 code for generalized weakness. As always, we’re here to help educate—so check our blog for more information on ICD-10 codes and when you should be using them in your practice.