Neurology & Pain Management Coding Alert
Understand Osteoarthritis Types for Spot-On Coding
Do you know when to report secondary OA? There will be times that patients report to the PM specialist in order to manage pain caused by osteoarthritis (OA). While you might think of certain anatomical areas — hips, knees, etc. — when you think about OA, the reality is that you can also find it in other anatomical locations. Challenge: When choosing a diagnosis code for OA, it’s often difficult to decide which type of OA the patient has. To make that call, you’ll need more than anatomical knowledge. Check out this advice on getting each of your OA patients’ diagnoses right every time. Know OA Types For coding purposes, there are six different types of OA. Check out this expert input on identifying each type. Polyosteoarthritis: Leading off the OA code set is this condition, in which OA is present in multiple sites. Polyosteoarthritis codes are different from other OA codes; they’re only four characters, and don’t go into great detail. The good news is that you’ll only have to identify the polyosteoarthritis type to complete your ICD-10 coding. The polyosteoarthritis codes are: Example: Notes indicate that the provider treated a patient with Heberden’s nodes with arthropathy. For this patient, you’ll report M15.1. Primary osteoarthritis: This type of OA “develops over time with degeneration, inflammation, and just plain wear and tear to the joint,” explains Kaitlyn Bohrer, COSC, of Eastside Orthopedics & Sports Medicine in Milwaukie, Oregon. Secondary osteoarthritis: Primary OA occurs just due to wear and tear, but secondary OA “is caused by a known reason or consequence. A primary condition or diagnosis you may find attached to secondary OA is mostly contributory to underlying conditions such as obesity, genetics, inactivity, and a large inventory of other diseases,” explains Bohrer. Posttraumatic osteoarthritis: Posttraumatic OA is a subtype of secondary OA. The condition “is contributory to a particular trauma or injury such as a subsequent fracture to a bone after playing a sport or an injury due to a car accident,” says Bohrer. Dysplastic osteoarthritis: This OA type, specific to the hips, “is caused by the hip not being in alignment. It wears down the cartilage and after time leads to osteoarthritis in the joint,” according to Alicia Scott CPC, CPC-I, CRC, director of education for CCO.us. “Dysplasia of the hip ultimately causes the hip joint to become partially or completely dislocated from the socket; this occurs when the socket portion does not fully cover the ball portion of the upper thighbone. The condition is largely developmental and has a high risk of dysplastic arthritis because of the constant depletion of the smooth cartilage on the bones that helps them glide fluently against each,” Bohrer continues. Other osteoarthritis: Other OA is what you assign OA when “the provider has identified specificity; however, there is not a code for [the OA identified] at this time,” says Scott. Get to Know OA Codes There are several anatomic areas represented in the OA codes section of ICD-10. Here’s an overview of the OA code set: 5th character alert: Remember that not all OA ICD-10 codes are four characters; several of the codes go into a 5th character, so be sure you code to the 5th character when ICD-10 instructs. Follow These Steps to Complete OA Dx There is a process designed to get you to the most accurate OA code. Here’s instruction on how to arrive at the best OA ICD-10 code for each patient. Step 1: Identify the location of the OA. Example: Notes indicate the patient suffered knee OA. Step 2: Identify the type of OA. This could be polyosteoarthritis, primary, secondary, posttraumatic, dysplastic, or other. Example: Notes indicate the patient suffered posttraumatic knee OA. Step 3: Identify the laterality of the OA. This could be left, right, or bilateral. Example: Notes indicate the patient suffered posttraumatic right knee OA. Step 4: Choose an OA code. For the example above, you’d report M17.31 (Unilateral post-traumatic osteoarthritis, right knee) for the patient. Remember Extra Step for Secondary OA If you find you’ve got a patient with secondary OA, you’ll need to add another step to the above instructions to completely code the patient. Reporting primary condition: You’ll need to find out what primary condition the patient suffers from in order to code secondary OA patients completely.
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