Orthopedic Coding Alert

Question: The orthopedist performed an office evaluation and management (E/M) service for an established 12-year-old female patient. The service lasted 24 minutes, and the surgeon performed low-complexity medical decision making (MDM). Diagnosis was “Scheurman’s disease, lumbosac region.” This disease isn’t one that I am familiar with. What is the correct diagnosis code for this encounter?

Michigan Subscriber

Answer: You might not be familiar with Scheurman’s disease, but you’ve probably heard of spinal osteochondrosis. The terms are interchangeable, and when you look up Scheurman’s disease in the ICD-10 index, it directs you to “Osteochondrosis, juvenile, spine.”

So on the claim, you’d append M42.07 (Juvenile osteochondrosis of spine, lumbosacral region) to 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 this encounter.

One more thing: Speaking of synonyms, spinal osteochondrosis is also referred to as “Calve’s disease.” When you see this term in the notes, check into the M42.0- (Juvenile osteochondrosis of spine) code set.