Polymyalgia rheumatica (PMR) — a systemic inflammatory syndrome of older adults producing proximal bilateral pain and stiffness in the shoulder and hip girdles, typically accompanied by elevated inflammatory markers.
Verified May 8, 2026 · 4 sources ↓
- Status
- Billable
- Chapter
- 13
- Related CPT
- 5
- Region
- Multi-region
Documentation tips
What should appear in the chart to support M35.3.
Source · Editorial brief grounded in 4 cited references ↓
- Record bilateral proximal pain distribution explicitly — shoulders, neck, hip girdle, or thighs — to distinguish PMR from localized myalgia codes.
- Document morning stiffness duration (ideally ≥45–60 minutes) and how long symptoms have been present before the visit.
- Record ESR and/or CRP values with the date drawn; elevated inflammatory markers are a core diagnostic criterion and support medical necessity for treatment.
- State the absence of giant cell arteritis symptoms (headache, jaw claudication, visual changes) or confirm GCA co-diagnosis — the Excludes1 rule between M35.3 and M31.5 hinges on this distinction.
- If steroid therapy is initiated, document the clinical response, which supports the PMR diagnosis retrospectively and is relevant for ongoing management encounters.
Related CPT procedures
Procedure codes commonly billed with M35.3. Linking the right diagnosis to the right procedure is what establishes medical necessity.
Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis
Common coding pitfalls
The recurring mistakes coders make with M35.3 and adjacent codes.
Source · Editorial brief grounded in CDC ICD-10-CM tabular guidance, AAOS coding references, and cited references ↓
- Using M79.1 (myalgia) instead of M35.3 when the provider has explicitly documented a PMR diagnosis — M79.1 is a nonspecific symptom code and undercodes a confirmed systemic condition.
- Assigning M35.3 alongside M31.5 on the same claim — the Excludes1 note prohibits this; when GCA accompanies PMR, code only M31.5.
- Omitting M35.3 as an additional diagnosis on encounters where the patient is being managed for PMR but presenting for a related complication such as steroid-induced osteoporosis or glucose dysregulation — PMR should still be listed as a chronic condition driving treatment.
- Confusing the index entries 'Forestier's disease' and 'rhizomelic pseudopolyarthritis' as distinct conditions requiring different codes — both map to M35.3.
Clinical context
Source · Editorial summary grounded in 4 cited references ↓
M35.3 is the sole ICD-10-CM code for polymyalgia rheumatica. There is no laterality and no severity subclassification — the condition is inherently bilateral and systemic, so a single code covers the full presentation. Use it when the clinician has documented a PMR diagnosis supported by clinical criteria: proximal girdle pain (shoulders, neck, hips, or thighs), morning stiffness lasting more than 45–60 minutes, age typically 50 or older, and elevated inflammatory markers such as ESR or CRP.
Critical exclusion: do NOT assign M35.3 when PMR is documented concurrently with giant cell arteritis (GCA). The Tabular List contains an Excludes1 note — M35.3 vs. M31.5 (giant cell arteritis with polymyalgia rheumatica). When both conditions are confirmed and documented together, use M31.5 only; M35.3 is excluded from that encounter by definition.
M35.3 sits in the M30–M36 block (Systemic connective tissue disorders) under parent code M35 (Other systemic involvement of connective tissue). It is also indexed under Forestier's disease and rhizomelic pseudopolyarthritis — terms occasionally used by older-generation clinicians. If the note uses those terms, M35.3 is still the correct code. Do not downcode to M79.1 (myalgia) or M79.3 (panniculitis) when PMR criteria are met and the provider has stated the diagnosis.
Inclusion & exclusion notes
Per the official ICD-10-CM Tabular List.
Source · CDC ICD-10-CM Official Tabular List · 2026
Excludes 1 — never code together
- polymyalgia rheumatica with giant cell arteritis (M31.5)
Sibling codes
Other billable codes under M35 (laterality / anatomic variants).
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01Can M35.3 and M31.5 be billed together on the same claim?
02Is there a more specific PMR code based on severity or girdle involved?
03What if the provider documents 'myalgia' without specifying PMR — can I code M35.3?
04Is M35.3 appropriate for an encounter focused on managing steroid side effects in a PMR patient?
05Does M35.3 require a 7th character or any extension?
06How is M35.3 indexed under Forestier's disease?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CDC ICD-10-CM Tabular List 2026 (effective Oct 1, 2025)
- 02icd10data.comhttps://www.icd10data.com/ICD10CM/Codes/M00-M99/M30-M36/M35-/M35.3
- 03aapc.comhttps://www.aapc.com/codes/icd-10-codes/M35.3
- 04icdcodes.aihttps://icdcodes.ai/diagnosis/polymyalgia-rheumatica/documentation
Mira AI Scribe
The Mira AI Scribe captures bilateral proximal girdle pain location, morning stiffness duration, symptom onset timeline, ESR/CRP values, and the provider's explicit PMR diagnosis statement — along with a note on whether GCA symptoms are present or absent. This prevents downcoding to nonspecific myalgia (M79.1) and flags the Excludes1 conflict with M31.5 before the claim is submitted.
See how Mira captures M35.3 documentation