Orthopedic Coding Alert

ICD-10 no longer has group unspecified locations alongside the specific locations for each type,

You may be used to choosing your osteoarthrosis based on anatomical location and status, but that all changes in ICD-10. Find out how to navigate the various possibilities — and how your physician’s documentation has to expand.

First, Examine the Coding Options For Both Dx Systems

Osteoarthrosis is a noninflammatory degenerative joint disease. The patient usually has degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. He or she usually complains of pain and stiffness.

ICD-9-CM Codes: Currently, you should report this condition with one of the following numerous options:

• 715.00, Osteoarthrosis generalized involving unspecified site
• 715.04, Osteoarthrosis generalized involving hand
• 715.09, Osteoarthrosis generalized involving multiple sites
• 715.10, Osteoarthrosis localized primary involving specified site
• 715.11, Osteoarthrosis localized primary involving shoulder region
• 715.12, Osteoarthrosis localized primary involving upper arm
• 715.13, Osteoarthrosis localized primary involving forearm
• 715.14, Osteoarthrosis localized primary involving hand
• 715.15, Osteoarthrosis localized primary involving pelvic region and thigh
• 715.16, Osteoarthrosis localized primary involving lower leg
• 715.17, Osteoarthrosis localized primary involving ankle and foot
• 715.18, Osteoarthrosis localized primary involving other specified sites
• 715.20, Osteoarthrosis localized secondary involving unspecified site
• 715.21, Osteoarthrosis localized secondary involving shoulder region
• 715.22, Osteoarthrosis localized secondary involving upper arm
• 715.23, Osteoarthrosis localized secondary involving forearm
• 715.24, Osteoarthrosis localized secondary involving hand
• 715.25, Osteoarthrosis localized secondary involving pelvic region and thigh
• 715.26, Osteoarthrosis localized secondary involving lower leg
• 715.27, Osteoarthrosis localized secondary involving ankle and foot
• 715.28, Osteoarthrosis localized secondary involving other specified sites
• 715.30, Osteoarthrosis localized not specified whether primary or secondary involving unspecified site
• 715.31, Osteoarthrosis localized not specified whether primary or secondary involving shoulder region
• 715.32, Osteoarthrosis localized not specified whether primary or secondary involving upper arm
• 715.33, Osteoarthrosis localized not specified whether primary or secondary involving forearm
• 715.34, Osteoarthrosis localized not specified whether primary or secondary involving hand
• 715.35, Osteoarthrosis localized not specified whether primary or secondary involving pelvic region and thigh
• 715.36, Osteoarthrosis localized not specified whether primary or secondary involving lower leg
• 715.37, Osteoarthrosis localized not specified whether primary or secondary involving ankle and foot
• 715.38, Osteoarthrosis localized not specified whether primary or secondary involving other specified sites
• 715.90, Osteoarthrosis unspecified whether generalized or localized involving unspecified site
• 715.91, Osteoarthrosis unspecified whether generalized or localized involving shoulder region
• 715.92, Osteoarthrosis unspecified whether generalized or localized involving upper arm
• 715.93, Osteoarthrosis unspecified whether generalized or localized involving forearm
• 715.94, Osteoarthrosis unspecified whether generalized or localized involving hand
• 715.95, Osteoarthrosis unspecified whether generalized or localized involving pelvic region and thigh
• 715.96, Osteoarthrosis unspecified whether generalized or localized involving lower leg
• 715.97, Osteoarthrosis unspecified whether generalized or localized involving ankle and foot
• 715.98, Osteoarthrosis unspecified whether generalized or localized involving other specified sites
• M15.0, Primary generalized (osteo)arthritis
• M15.1,Heberden's nodes (with arthropathy)
• M15.2, Bouchard's nodes (with arthropathy)
• M15.3, Secondary multiple arthritis
• M15.4, Erosive (osteo)arthritis
• M15.8, Other polyosteoarthritis
• M15.9, Polyosteoarthritis, unspecified
• M16.0, Bilateral primary osteoarthritis of hip
• M16.10, Unilateral primary osteoarthritis, unspecified hip
• M16.11, Unilateral primary osteoarthritis, right hip
• M16.12, Unilateral primary osteoarthritis, left hip
• M16.2, Bilateral osteoarthritis resulting from hip dysplasia
• M16.30, Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip
• M16.31, Unilateral osteoarthritis resulting from hip dysplasia, right hip
• M16.32, Unilateral osteoarthritis resulting from hip dysplasia, left hip
• M16.4, Bilateral post-traumatic osteoarthritis of hip
• M16.50, Unilateral post-traumatic osteoarthritis, unspecified hip
• M16.51, Unilateral post-traumatic osteoarthritis, right hip
• M16.52, Unilateral post-traumatic osteoarthritis, left hip
• M16.6, Other bilateral secondary osteoarthritis of hip
• M16.7, Other unilateral secondary osteoarthritis of hip
• M16.9, Osteoarthritis of hip, unspecified
• M17.0, Bilateral primary osteoarthritis of knee
• M17.10, Unilateral primary osteoarthritis, unspecified knee
• M17.11, Unilateral primary osteoarthritis, right knee
• M17.12, Unilateral primary osteoarthritis, left knee
• M17.2, Bilateral post-traumatic osteoarthritis of knee
• M17.30, Unilateral post-traumatic osteoarthritis, unspecified knee
• M17.31, Unilateral post-traumatic osteoarthritis, right knee
• M17.32, Unilateral post-traumatic osteoarthritis, left knee
• M17.4, Other bilateral secondary osteoarthritis of knee
• M17.5, Other unilateral secondary osteoarthritis of knee
• M17.9, Osteoarthritis of knee, unspecified
• M18.0, Bilateral primary osteoarthritis of first carpometacarpal joints
• M18.10, Unilateral primary osteoarthritis of first carpometacarpal joint unspecified hand
• M18.11, Unilateral primary osteoarthritis of first carpometacarpal joint, right hand
• M18.12, Unilateral primary osteoarthritis of first carpometacarpal joint, left hand
• M18.2, Bilateral post-traumatic osteoarthritis of first carpometacarpal joints
• M18.30, Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, unspecified hand
• M18.31, Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, right hand
• M18.32, Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, left hand
• M18.4, Other bilateral secondary osteoarthritis of first carpometacarpal joints
• M18.50, Other unilateral secondary osteoarthritis of first carpometacarpal joint, unspecified hand
• M18.51, Other unilateral secondary osteoarthritis of first carpometacarpal joint, right hand
• M18.52, Other unilateral secondary osteoarthritis of first carpometacarpal joint, left hand
• M18.9, Osteoarthritis of first carpometacarpal joint, unspecified
• M19.011,Primary osteoarthritis, right shoulder
• M19.012, Primary osteoarthritis, left shoulder
• M19.019, Primary osteoarthritis, unspecified shoulder
• M19.021, Primary osteoarthritis, right elbow
• M19.022, Primary osteoarthritis, left elbow
• M19.029, Primary osteoarthritis, unspecified elbow
• M19.031, Primary osteoarthritis, right wrist
• M19.032, Primary osteoarthritis, left wrist
• M19.039, Primary osteoarthritis, unspecified wrist
• M19.041, Primary osteoarthritis, right hand
• M19.042, Primary osteoarthritis, left hand
• M19.049, Primary osteoarthritis, unspecified hand
• M19.071, Primary osteoarthritis, right ankle and foot
• M19.072, Primary osteoarthritis, left ankle and foot
• M19.079, Primary osteoarthritis, unspecified ankle and foot
• M19.111, Post-traumatic osteoarthritis, right shoulder
• M19.112, Post-traumatic osteoarthritis, left shoulder
• M19.119, Post-traumatic osteoarthritis, unspecified shoulder
• M19.121, Post-traumatic osteoarthritis, right elbow
• M19.122, Post-traumatic osteoarthritis, left elbow
• M19.129, Post-traumatic osteoarthritis, unspecified elbow
• M19.131, Post-traumatic osteoarthritis, right wrist
• M19.132, Post-traumatic osteoarthritis, left wrist
• M19.139, Post-traumatic osteoarthritis, unspecified wrist
• M19.141, Post-traumatic osteoarthritis, right hand
• M19.142, Post-traumatic osteoarthritis, left hand
• M19.149, Post-traumatic osteoarthritis, unspecified hand
• M19.171, Post-traumatic osteoarthritis, right ankle and foot
• M19.172, Post-traumatic osteoarthritis, left ankle and foot
• M19.179, Post-traumatic osteoarthritis, unspecified ankle and foot
• M19.211, Secondary osteoarthritis, right shoulder
• M19.212, Secondary osteoarthritis, left shoulder
• M19.219, Secondary osteoarthritis, unspecified shoulder
• M19.221, Secondary osteoarthritis, right elbow
• M19.222, Secondary osteoarthritis, left elbow
• M19.229, Secondary osteoarthritis, unspecified elbow
• M19.231, Secondary osteoarthritis, right wrist
• M19.232, Secondary osteoarthritis, left wrist
• M19.239, Secondary osteoarthritis, unspecified wrist
• M19.241, Secondary osteoarthritis, right hand
• M19.242, Secondary osteoarthritis, left hand
• M19.249, Secondary osteoarthritis, unspecified hand
• M19.271, Secondary osteoarthritis, right ankle and foot
• M19.272, Secondary osteoarthritis, left ankle and foot
• M19.279, Secondary osteoarthritis, unspecified ankle and foot
• M19.90, Unspecified osteoarthritis, unspecified site
• M19.91, Primary osteoarthritis, unspecified site
• M19.92, Post-traumatic osteoarthritis, unspecified site
• M19.93, Secondary osteoarthritis, unspecified site

Second, Translate This Into Specific Changes

All of your 715.xx codes will convert to codes from the Osteoarthritis section (M15-M19) of your ICD-10-CM manual. These categories are as follows:

• M15 (Polyosteoarthritis)
  
• M16 (Osteoarthritis of hip)
  
• M17 (Osteoarthritis of knee)
  
• M18 (Osteoarthritis of first carpometacarpal joint)
  
• M19 (Osteoarthritis of other joints).
  

What’s different: In ICD-9-CM, your osteoarthrosis codes (715.xx) specify the anatomical location (such as knee, hip, etc.) and status (primary, secondary, or unspecified).

In ICD-10-CM you will choose your code based on the following information:

1. the anatomical location (such as knee, hip, etc.)
2. status (primary, secondary, post-traumatic, or unspecified)
3. whether the osteoarthrosis is right, left, or bilateral, or unspecified

Note: The specific term “post-traumatic osteoarthritis status” is new, as in ICD-9, you would report this status as “traumatic arthropathy” with codes 716.11-716.19. As of October 1, 2014, ICD-10-CM more appropriately indexes this condition and describes it as post-traumatic osteoarthritis, the true condition.

You do have unspecified codes, but you should always try to code to the highest level of specificity.

Finally, Take These Documentation/Coding Tips to Heart

Documentation: To submit the most detailed diagnosis, the orthopedic physician will need to maintain osteoarthrosis documentation but expand it to unilateral, bilateral, and/or post-traumatic specification. Some key terms are “osteoarthritis,” “arthritis,” “arthrosis,” “DJD,” “arhtropathy,” “post traumatic arthritis,” and “traumatic arthritis.”

Coder tips: Notice how codes M19.01-M19.93 entail unspecified locations. ICD-10 no longer has group unspecified locations alongside the specific locations for each type (as in, the familiar .9 code in most ICD-9 categories). You will find them at the end of the code grouping (M19.90-M19.93) for each specific type but in an unspecified location.

In addition, traumatic osteoarthritis is now more appropriately indexed and described as post-traumatic osteoarthritis, the true condition.

Be sure to look at all your Includes and Excludes notes. For instance, you cannot report osteoarthritis of spin (M47.-) with all of the codes in the M15-M19 series.