ED Coding and Reimbursement Alert

uestion: Our ED physician saw a patient who presented with right shoulder pain, and he diagnosed her with acute osteomyelitis. Which is the correct ICD-10 code for this condition?

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Answer: Your primary diagnosis will be one of two codes, but before you decide for sure, you’ll need to go back and check the encounter notes, and then choose one of these diagnosis codes:

• M86.011 (Acute hematogenous osteomyelitis, right shoulder)
• M86.111 (Other acute osteomyelitis, right shoulder)

Secondary Dx alert: In the section devoted to osteomyelitis, ICD-10 instructs coders to use an additional code to identify the infectious agent underlying the condition. You’ll choose a code from one of the following code sets to ID the infectious agent:

• B95.- (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere)
• B96.- (Other bacterial agents as the cause of diseases classified elsewhere)
• B97.- (Viral agents as the cause of diseases classified elsewhere)

Some of these codes require a fourth character, while others in the same family might require you to code to the fifth character. Keep this in mind as you sift through these secondary diagnoses. Of note, the specific organism is rarely available in the ED setting.

Third Dx possible: Not only should you include an infectious agent code secondary to the osteomyelitis, you might need a third diagnosis to identify a major osseous defect, if applicable. In this patient’s case, you’ll choose M89.711 (Major osseous defect, right shoulder region) if the patient has a major osseous defect in addition to the acute osteomyelitis.