Internal Medicine Coding Alert

Familiarize yourself with few codes that will have broader application.

Your diagnosis choices for connective tissue disorders will expand dramatically when ICD-10 goes into effect in October 2014. Here's what you'll need to know about which descriptors will change -- and which won't -- to ensure you pinpoint the most accurate code every time.

Get Specific With Muscle Spasm Coding

Muscle spasm coding gets more complicated than you might think with ICD-10.

Currently: ICD-9 includes only a single code for muscle spasm: 728.85 (Spasm of muscle). The diagnosis includes any type of spasm, ranging from those due to injury or stroke to conditions in which the brain or spinal cord is destroyed (such as cerebral palsy or multiple sclerosis). This includes muscle contractures not elsewhere classified in ICD-9.

Looking ahead: Once ICD-10 goes into effect, you'll have three choices for muscle spasm, depending on the location of the muscle in question:

• M62.830 -- Muscle spasm of back
• M62.831 -- Muscle spasm of calf (Commonly referred to as a "Charley horse")
• M62.838 -- Other muscle spasm.

Although the choice seems simple, you'll need to know the potential reversibility of the related muscle spasm/contraction in order to code correctly between a muscle spasm and a muscle contraction. If the muscle has contracted, become shortened, and fixes the limb permanently in one position, you'll report a code from the series M62.40-M62.49, which is for contracture of the muscle. However, if the contraction has some potential of reversibility, you'll submit one of the three muscle spasm codes noted above.

"ICD-10 is supplying a very specific code for muscle contracture," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding. "ICD-10 has supplied 24 codes from M62.40 through M62.49 to specify specific locations, right versus left, an unspecified code for each body location for use when 'right' or 'left' are not clarified, and for 'other site' and 'multiple sites'."

Mark These Codes That Will Have Broader Descriptors

In most instances, ICD-10 will introduce a greater number of choices for diagnoses than ICD-9, or at least offer more specific diagnoses than you currently have. Another example of that trend is ligament disorders.

Example 1: ICD-9 currently includes a single diagnosis code for ligament laxity, 728.4 (Laxity of ligament). It will be replaced under ICD-10 by multiple codes that have more specificity, beginning with M24.20 (Disorder of ligament, unspecified site) and running through M24.28 (Disorder of ligament, vertebrae). The descriptors include disorders other than a lax ligament; for instance, instability secondary to an old ligament injury would also be reported with this series of codes. These codes do not, however, include familial ligamentous laxity. You will need to use M35.7 (Hypermobility syndrome) for that condition.

Example 2: ICD-9 code 728.89 (Other disorders of muscle, ligament, and fascia) covers muscles, ligaments, and fascia. The corresponding ICD-10 codes are more specific. For instance, M62.89 (Other specified disorders of muscle) is specific to muscle disorders, including the fascia, whereas you will need to use a code in the M24.2_ series for any disorder of a ligament.

"ICD-10 has listed a code specific to the muscle alone," Stumpf says. "There is also a specific code for disorder of ligament for ICD-10. The ligamentous disorder code is broken down by location and right versus left, with an unspecified code for each body area when right and left are not listed. Coders can now be more specific as the actual tissue affected."

Check Out These Descriptors That Won't Change

Many other connective tissue disorders your internal medicine specialist might diagnose will retain their descriptors under ICD-10. Consider these examples of diagnoses where you'll learn new codes but not new descriptors:

• Hypermobility syndrome (728.5) will become M35.7
• Plantar fascial fibromatosis (728.71) will change to M72.2
• Necrotizing fasciitis (728.86) will shift to M72.6
• Generalized muscle weakness (728.87) will become M62.81
• Ehlers-Danlos syndrome (756.83) will update to Q79.6. "This commonly described condition may manifest as hypermobility and may present with ligamentous hyperlaxity," explains Bill Mallon, MD, medical director of Triangle Orthopedic Associates in Durham, N.C.