Myositis is a condition where the muscles swell, causing weakness and
often pain. Myositis can be caused by medications, medical conditions like
cancer, etc., but in the majority of cases, the cause is unknown.
Before discussing rating options, it should be noted that in addition to
general myositis, there are a few specific types of myositis that present with
special symptoms.
- Polymyositis affects numerous muscles all over the body, and in its
severe form, can lead to other serious condition such as difficulty swallowing,
lung disease, and heart disease.
- Dermatomyositis is similar to polymyositis but it also includes the
skin, causing rashes along with the muscle weakness and other symptoms.
- Inclusion-body myositis is very similar to polymyositis. There are, of
course, differences, but they are pretty technical and aren’t relevant to
ratings, so we won’t get into the medical jargon here.
On to the ratings.
The
VASRD code for Myositis
is
code 5021. For most cases of myositis, regardless of type, this will be
the main code assigned. Code 5021 is rated on limited motion of the affected
joints. So if the condition causes limited motion of the elbow and knee, then
two ratings will be given: one for limited motion of the elbow, and one for
limited motion of the knee.
Now as mentioned
above, myositis can cause many other symptoms in addition to limited motion,
like skin rashes and heart disease. In cases where there are symptoms other
than limited motion that cause significant impairment, they can be rated
separately.
For example, let’s say
Shawn has dermatomyositis. His symptoms include rashes around his eyes and on
his neck, weakness in the shoulders that limits his ability to raise his arms,
and supraventricular arrhythmia (a heart condition).
Of these symptoms,
only the shoulders will be rated under code 5021 (the code for myositis) since
those are the only joints that have limited motion. As both shoulders are
affected, he will then receive two ratings under
code 5201 for limited motion of
the shoulder. Next, Shawn’s rashes will be rated as psoriasis under
code 7816.
And finally, his arrhythmia will be rated under
code 7010 for supraventricular
arrhythmia.
In total, Shawn will
receive 4 separate ratings for his dermatomyositis: shoulder, shoulder, skin,
heart. The final codes for these ratings will look like this:
5021-5201: left
shoulder limited motion
5021-5201: right
shoulder limited motion
5021-7816: psoriasis
5021-7010:
supraventricular arrhythmia
The hyphenated codes
are used to define the condition properly. The first four digits defines the
condition as myositis, and the second indicates how it is rated (limited motion
of the shoulder, psoriasis, etc.). See
Analogous Ratings for more info.
So ultimately when
rating myositis, additional ratings can be given for each separate symptom caused
by any type of myositis as long as none of the symptoms are rated more than
once (the
Pyramiding Principle).
For example, let’s say
Shawn has dermatomyositis. His symptoms include rashes around his eyes and on
his neck, weakness in the shoulders that limits his ability to raise his arms,
and supraventricular arrhythmia (a heart condition).