Orthopedic Coding Alert

Question: What is the difference between pathological dislocations and recurrent dislocations? Notes indicate that a patient with osteoporosis suffered pain from a “shoulder dislocation,” which the orthopedist treated three with trigger point injections (TPIs) into one muscle group. I’ve narrowed my ICD-10 choices to pathological and recurrent dislocations, but I’m stuck now.

Iowa Subscriber

Answer: You’re going to have to do a deep dive into the notes to find the correct ICD-10 code for this TPI claim, which you’d code with 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)).

According to codify.com, “pathological dislocation of the shoulder joint refers to a painful condition in which the bones of the joint are out of their normal position as a consequence of disease, not classifiable to any other code.” A pathological dislocation has not necessarily repeated itself — though it is possible that a pathological dislocation could occur more than once. The driving factor is that the underlying cause of the dislocation is disease, such as osteoporosis.

If you can prove that the dislocation is due to the patient’s osteoporosis, you’d choose one of the following codes for pathological shoulder dislocation, depending on encounter specifics:

• M24.311 (Pathological dislocation of right shoulder, not elsewhere classified)
• M24.312 (Pathological dislocation of left shoulder, not elsewhere classified)
• M24.319 (Pathological dislocation of unspecified shoulder, not elsewhere classified)

Codify.com states that “recurrent dislocation of the shoulder joint refers to the repeated displacement of the bones of the joint from their normal alignment due to traumatic or nontraumatic events such as a previous injury, repetitive strain, or an inherited laxity, or looseness, of the joint.” This definition spells out that the dislocation has happened before, unlike the definition for a pathological dislocation.

If notes indicate that the same shoulder dislocation has happened before, you’d choose one of the following codes for recurrent shoulder dislocation, depending on encounter specifics:

• M24.411 (Recurrent dislocation, right shoulder)
• M24.412 (Recurrent dislocation, left shoulder)
• M24.419 (Recurrent dislocation, unspecified shoulder)