Orthopedic Coding Alert

Question: Which diagnosis code should we report for an olecranon bone spur? ICD-9 points to 726.91, but several insurers will not accept unspecified codes. Should I use 213.4 (Benign neoplasm of bone and articular cartilage; scapula and long bones of upper limb) instead?

Ohio Subscriber

Answer: Many coders share your frustration with this scenario because the ICD-9 index refers you to the enthesopathy codes for spurs of certain anatomic sites (such as calcaneus and iliac crest), but not others, such as the elbow. 
 
Most coding experts don't recommend reporting 726.91 (Exostosis of unspecified site) for bone spurs because the descriptor refers to an "unspecified site." Because you know that the patient has an olecranon spur, your patient's site can no longer be considered "unspecified."
 
Orthopedists don't usually remove spurs unless the spur irritates the surrounding tissue. If the spur causes such irritation, you can report an enthesopathy code.
 
With that in mind, if your surgeon removes the olecranon spur because it causes chronic irritation of the surrounding muscle, tendon or ligament, you should report 726.39 (Enthesopathy of elbow region; other).