Home Health ICD-9/ICD-10 Alert

Published on Thu Jan 22, 2009 PDF

Question: What is the correct diagnosis for patients with degenerative joint disease of the knee?

Answer: The answer depends on whether the physician documents the degenerative joint disease (DJD) as primary, secondary, or unspecified:

• If your documentation supports localized primary disease, submit 715.16 (Osteoarthrosis, localized, primary; lower leg).

• If your physician documents secondary disease, a diagnosis such as 715.26 (Osteoarthrosis, localized, secondary) might apply.

• If you do not have documentation to support primary or secondary, report 715.36 (Osteoarthrosis, localized, not specified whether primary or secondary; lower leg).

Although the joint disease is usually primary (715.16), if your physician doesn't specify "primary"  in his diagnostic statement, you can't make that assumption. Instead, report 715.36.

Primary means that the condition is related to the aging process. Secondary means that trauma, genetics, or a secondary condition such as diabetes is contributing to the osteoarthrosis.

Bilateral tip: Don't miss the note with code family 715 explaining that, "Localized, in the subcategories below, includes bilateral involvement of the same site."

If the patient exhibits degenerative joint disease in both knees, report the appropriate diagnosis code only once. If only one site or one site bilaterally is mentioned, code subcategory 715.3x.