Orthopedic Coding Alert

Unspecified location? Look to the M19 codes. When ICD-9 becomes ICD-10 in 2013, you will not always have a simple one-to-one relationship between old codes and the new ones. Often, you'll have more options that may require tweaking the way your physician documents a service and a coder reports it. Check out these common osteoarthrosis diagnoses, and discover what you'll report after October 1, 2013. Typically a patient with osteoarthritis might start with his primary care physician, who then refers him to a rheumatologist. The rheumatologist has been treating the patient with conservative measures such as NSAIDS (nonsteroidal anti-inflammatory drugs). Due to increasing symptoms, now poorly controlled by the use of NSAIDS, the rheumatologist requests an orthopedic consultation. He diagnoses osteoarthrosis(715.xx-716. xx). These codes specify location, primary, or secondary. ICD-10 difference: For these codes, you should look to:

• M15 (Polyosteoarthritis)
• M16 (Osteoarthritis of hip)
• M17 (Osteoarthritis of knee)
• M18 (Osteoarthritis of first carpometacarpal joint)
• M19 (Other and unspecified osteoarthritis).

These codes are broken down into location, primary, and secondary like your ICD-9 codes, but they also sometimes specify unilateral, bilateral, and posttraumatic indications. Physician 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.