Charcot Joints
Historically, Charcot Joints were the result of advanced and severe Syphilitic brain/cerebral disease (Tabes Dorsalis). The resulting "neuropathy" from syphilis caused loss of multiple aspects of sensation (particularly pain sensation), loss of strength and coordination in the limbs resulting in a progressive "Neuropathic Arthropathy" in that the joints involved "self-destructed" over time. The most commonly affected joints were the weight bearing joints of the lower extremities, particularly the ankle and foot. Today the most common cause of this phenomenon is Diabetes, in an advanced or end stage of Diabetic Neuropathy and Diabetic Arthropathy. The progressive "self-destruction" process results in boney destruction (chronic fractures) and loss of joint integrity (subluxations and dislocations). In the Coding for this disorder, if all the boney and joint abnormalities identified in a patient are felt to be chronic and long standing, then I would think you would only have to code the Charcot Joint, and not code each and every chronic fracture &/or joint deformity individually. If this is the result of Diabetes, then you would choose the type of Diabetes (E10, E11, E13) with .610 for Diabetic Neuropathic Arthropathy. If the underlying disease is not Diabetes or Syphilis, the M14.6 _ _ (5th Character 1 through 9 for body region, and 6th Character for laterality) would apply.
If, however, a new or acute fracture or joint subluxation/dislocation is identified superimposed on a known chronic Charcot Joint (i.e. an acute on chronic situation), then I would code both the acute fracture and the Charcot Joint code.
I hope this helps.
Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com