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Fibromyalgia N073

Document
Last amended 
26 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
13 of 2014
Balance of Probabilities SOP
14 of 2014
Changes from Previous Instruments:

SOP Bulletin 171

 ICD Coding:
  • ICD-9-CM Codes: 729.1
  • ICD-10-AM Codes: M79.7

Literally this means pain in the muscles and fibrous tissue. This is a functional disorder with no objective evidence of pathology, with diffuse pain in all four quadrants of the body. This diagnosis is only made when there is no other psychiatric or physical condition which could explain it.  Fibromyalgia is specified according to the severity of pain (symptom severity scale score) and the diffuse pain locations (widespread pain index).

Is specific diagnostic evidence required to apply the SOP?Yes.

This diagnosis is complex and is a diagnosis of exclusion. Hence an opinion from a specialist rheumatologist with exclusion imaging and blood tests is required.

Are there sub-factors that require specific information? – No.
Additional diagnoses covered by SOP
Conditions excluded from SOP
  • Symptom or manifestation of psychiatric conditions such as depression.
  • Conversion disorder
  • Pain disorder with psychological factors; pain disorder with psychological factors and a general medical condition.
  • Somatic symptom disorder (DSM-5).
  • Complex regional pain syndrome types 1 and 2.
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then seek medical officer advice about further investigation.