Orthopedic Coding Alert

Question: What is the correct diagnosis for patients with degenerative joint disease of the knee?

Minnesota Subscriber

Answer: The answer depends on whether your physician documents the degenerative joint disease (DJD) as primary, secondary, or unspecified:

• If you have documentation of localized primary disease, submit 715.16 (Osteoarthrosis, localized, primary; lower leg).

• If your physician documents secondary disease, a diagnosis such as 715.2x (Osteoarthrosis, localized, secondary) might apply.

• If you do not have documentation to support primary or secondary, report 715.36 (Osteoarthrosis, localized, not specified whether primary or secondary; lower leg). Although the joint disease usually is primary (715.16), if your physician doesn't specify "primary" in his diagnostic statement, you can't make that assumption. Instead, report 715.36.

Bilateral tip: Don't miss the note with code family 715 explaining that, "Localized, in the subcategories below, includes bilateral involvement of the same site." If the patient exhibits degenerative joint disease in both knees, report the appropriate diagnosis code only once.