Neurosurgery Coding Alert

Question: What is the difference between an arthritic condition that can be coded with a 716 series code and an arthritic condition that can be coded with a 715 series code?

Pamela Lee
Orlando, Fla.

Answer: Accurate coding of arthritic conditions requires specific information from the physician, says Heidi Stout, CPC, coding and reimbursement manager for University Orthopaedic Associates, a multi-physician orthopedic practice in New Brunswick, N.J. There are many ICD-9 codes to choose from in each series, and insufficient information can lead to inaccurate coding. If the physician records a diagnosis of arthritis of the knee, a coder should request more specific diagnostic information before coding it.

Arthritic conditions such as osteoarthrosis or degenerative joint disease should be reported using the 715 series. Other and unspecified arthropathies, including post-traumatic arthritis (arthritis that develops as a late effect of injury) (716.1x), allergic arthritis (716.2x) and transient arthropathy (716.4x) (excluding palindromic rheumatism [719.3]), may be reported using a code from the 716 range. Both ranges of codes must be coded to the fifth digit. The fifth digit range for these codes is as follows: 0, site unspecified; ,1 shoulder region; 2, upper arm; 3, forearm; 4, hand; 5, pelvic region and thigh; 6, lower leg; 7, ankle and foot; 8, other specified sites; 9, multiple sites.

Note: The 716 range excludes cricoarytenoid arthropathy (478.79)

To make matters more confusing, there are arthritis diagnosis codes that are not in the 715 or 716 range, including, but not limited to, gouty arthropathy (274.0), pyogenic arthritis (711.0x), psoriatic arthropathy (696.0), and rheumatoid arthritis (714.0).

If a coder is confronted with a diagnostic statement of arthritis and cannot obtain further clarification, ICD-9 code 716.9x (arthropathy, unspecified) may be reported. But this is a poor choice and may result in a claim denial because many carriers now refuse to accept unspecified diagnosis codes. Whenever possible, the coder should question the physician and obtain the specific information needed for accurate reporting of the patients condition.

Generally when arthritis occurs at the spine, it is coded under spinal stenosis (724.xx) because of the neural implications. Note that there is no specific fifth-digit designation in the 715/716 sections for spine. Arthritis generally would be noted by a neurosurgeon as a coexisting condition to a primary diagnosis such as carpal tunnel syndrome (354.0). Often, there are rheumatic nodules or rice bodies present at the wrist joint that are biopsied occasionally or excised in the course of a carpal tunnel release.