Oral Surgery Coding & Reimbursement Alert

Question: Our oral surgeon recently diagnosed a patient with osteonecrosis of the mandible. The patient was previously on bisphosphonates for treatment of early breast cancer. I am thinking of 526.4 although I am not too sure of reporting this ICD-9 code for the condition.

Ohio Subscriber

Answer: You are right in thinking that using 526.4 (Inflammatory conditions of jaw) is not very appropriate for osteonecrosis of the mandible caused due to the bisphosphonate therapy that the patient underwent. This ICD-9 code is used to describe inflammatory conditions such as an osteitis or osteomyelitis of the jaw bone and is not apt for use for a diagnosis of osteonecrosis of the jaw. In this case, you also cannot use 526.89 (Other specified diseases of the jaws). This ICD-9 code includes radiation-related necrosis of the jaw bones in its expanded descriptor.

For osteonecrosis of the jaw caused due to bisphosphonates, it is better to use the ICD-9 code, 733.45 (Aseptic necrosis of bone, jaw). If you look at the descriptor to 733.45, you will see that it mentions the phrase, “Use additional E code to identify drug, if drug-induced.” This phrase makes it more suitable to use this code for reporting a diagnosis of osteonecrosis that has been caused due to the use of a drug.

As the necrosis caused in the patient can be attributed to the bisphosphonate therapy, you will have to report an appropriate E-code to support the diagnosis. If the bisphosphonates was administered orally, you will have to additionally report E933.6 (Adverse effect of oral biphosphates). You will have to report E933.7 (Adverse effect of intravenous biphosphates) if the bisphosphonate therapy was through an intravenous route of administration. If other drugs were also used in combination, their adverse effects should be identified by using an appropriate E-code in addition to the above mentioned E-codes.

ICD-10: When you switch to using ICD-10 codes after Oct.1, 2015, you will have to use the following codes instead of the above mentioned ICD-9 codes:

• M87.180 (Osteonecrosis due to drugs, jaw) instead of 733.45
• T45.8X5S (Adverse effect of other primarily systemic and hematological agents, sequela). You report the “sequela” code instead of an “initial encounter (T45.8X5A)” code as the condition resulted as a later sequel to the administration of the bisphosphonates. You report the same code instead of “E933.6” as well as “E933.7” as there are no specific codes in ICD-10 to report adverse effects of oral and intravenous administration of bisphosphonates.