# Diagnosis code for Osteoarthritis



## rajkumark (Apr 8, 2011)

Hi All,

Can some one clarify the diagnosis code for Osteoarthritis knee right side – 715.96 or 715.36. 

As per the below link from AHA coding clinic source:

http://www.fortherecordmag.com/archives/ftr_121905p31.shtml

It should be coded as 715.36 for unilateral or bilateral involvement of OA. In what scenario/situation 715.96 can be coded, because it also has fifth digit for anatomical site like hip/knee etc. 

Thanks in advance!
Rajkumar Kuppuraj CPC


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## ohn0disaster (Apr 8, 2011)

I was taught that the doctor must distinguish between localized and generalized in his/her documentation to code it as such. If you look at your ICD-9 book, code 715.9X states "*Osteoarthrosis, unspecified whether generalized or localized*". We've all heard the saying that coders should never assume. So, to me, coding localized DJD for documention stating "OA of the right knee" is assuming that it really is localized, when it could have just been that the doctor was focusing on the right knee on that DOS because the patient brought up the fact that they were having pain or whatever. There would be no need for the "*unspecified whether generalized or localized*" code if we were supposed to use the localized code in the presence of documentation stating OA of [insert site here].

So as for me, until they decide to delete code 715.9X, I will let the doctor's documentation distinguish between localized, generalized, and NOS OA.


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## NaliniAAPC (Apr 11, 2011)

HI,
Agree with 715.96-Diagnosis code for Osteoarthritis...

Regards,
Nalini CPC


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## eadun2000 (Apr 11, 2011)

This is what Coding Clinic 2nd quarter 1995 states:

"Question: When a patient has degenerative joint disease of both knees, what is the correct code assignment? We assigned code 715.96, Osteoarthrosis, unspecified whether generalized or localized, knee. Should we utilize a code that identifies multiple sites, e.g., code 715.06, Osteoarthrosis, generalized, knee (involving multiple joints)?



Answer: Assign code 715.36, Osteoarthrosis, localized, not specified whether primary or secondary, for bilateral degenerative joint disease, knee. In the Tabular List (Volume 1), under category 715, Osteoarthrosis and allied disorders, an instructional note can be found:



NOTE: Localized, in the subcategories below, includes bilateral involvement of the same site.



This note should be interpreted to mean that bilateral involvement is included in the fifth digit for that site. Furthermore, when the degenerative joint disease affects only one site but is not identified as primary or secondary it is coded to 715.3x, Osteoarthrosis, localized, not specified whether primary or secondary. If it involves more than one site but is not specified as generalized, assign code 715.8x, Osteoarthrosis involving, or with mention of more than one site but not specified as generalized.



Question: What is the correct code assignment for degenerative joint disease of multiple sites?



Answer: Assign code 715.89, Osteoarthrosis involving, or with mention of more than one site but not specified as generalized, multiple sites, when degenerative joint disease affects multiple sites and is not identified as generalized.





Coding advice on code assignments contained in this issue is effective with discharges April 15, 1995.


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## ohn0disaster (Apr 12, 2011)

I am familiar with the pasted coding clinic, however, I still stand by my original statement. To assign as localized without provider confirmation would be assumption coding. Very simply, it depends on the documentation. As we all know, coding is not so very black and white. If we were to always assign either localized of generalized, there would be no need for unspecified codes. It would make sense if the only unspecified code was 715.90, for the DX of DJD/OA, but the 715.9X code allows for fifth digit 0-8. This means OA of the knees, DJD of the knees, unspecified as to whether generalized or localized = 715.96.


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## ohn0disaster (Apr 12, 2011)

eadun2000 said:


> This note should be interpreted to mean that bilateral involvement is included in the fifth digit for that site. *Furthermore, when the degenerative joint disease affects only one site but is not identified as primary or secondary it is coded to 715.3x, Osteoarthrosis, localized, not specified whether primary or secondary*. If it involves more than one site but is not specified as generalized, assign code 715.8x, Osteoarthrosis involving, or with mention of more than one site but not specified as generalized.



I just wanted to point out that this is directly contradicted in the Ingenix Diagnoses Coders' Desk Reference/Guidelines for Coding and Reporting 2011 edition that I hold in front of me.

*Coding Scenario*:
A patient is seen in the office for a follow-up examination of her osteoarthritis in the right knee.


Code assignment: 715.96 _Osteoarthritis, unspecified whether generalized or localized, lower leg (fibula, knee joint, patella, tibia)_​


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