Orthopedic Coding Alert

Question: Encounter notes indicate that the provider performed an office evaluation and management (E/M) service for an 11-year-old established patient. Encounter time was 26 minutes and notes indicate the final diagnosis was “Kaschin Beck, shoulder.” I’m stumped as to the diagnosis. Can you help?

Minnesota Subscriber

Answer: You’ll want to report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.) for the E/M.

The ICD-10 code could be one of three:

• M12.111 (Kaschin-Beck disease, right shoulder)
• M12.112 (Kaschin-Beck disease, left shoulder)
• M12.119 (Kaschin-Beck disease, unspecified shoulder)

Do this: Go back and check if the provider indicated laterality; if they did, choose M12.111 or M12.112. If there is no indication of laterality in the notes, opt for M12.119.

Background: Per ICD-10, “Kaschin-Beck is a disorder of bones and joints of hands, fingers, elbows, knees and ankles of children and adolescents.” An alternate term for the disorder is “osteochondroarthrosis deformans endemica.”