Wiki Guidance for selecting Acute vs Chronic Osteomyelitis with site when A/C unspecified

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AnneMorgan

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When osteomyelitis is unspecified as to acute or chronic in documentation, certainly best to query re status so location can be coded. But in absence of clarification, is there any guidance to select acute or chronic as default?

Thanks for your thoughts
 
According to the ICD-10-CM Official Guidelines for Coding and Reporting FY 2017, Section I.A.18. Default Codes:

"A code listed next to a main term in the ICD-10-CM Alphabetic Index is referred to as a default code. The default code represents that condition that is most commonly associated with the main term, or is the unspecified code for the condition. If a condition is documented in a medical record (for example, appendicitis) without any additional information, such as acute or chronic, the default code should be assigned."

Therefore, if based on the documentation you have, no other subcategory besides acute or chronic applies, then you would use the default code next to the diagnosis. In your case, it would be M86.9 Osteomyelitis, unspecified.

Dawn Wachtel, CPC, CPB
 
But when site is specified, just not as acute or chronic, how to capture the location? example osteomyelitis metatarsal. Must we lose the information given for location and use default unspecified M86.9 or is there any rationale under which could be assigned to M86.17 (if new Dx, fresh bone bx, is on IV abc etc) vs M86.18 (long term suppression abx, recurrence etc).
 
In this case, unfortunately, based on what I've read, the location would have to be lost! One of the supplemental terms listed next to the default code is "localized". Therefore, I feel this includes the cases where the localized site may be known, but due to lack of documentation, it can't be further classified. Hence, this explains why you have to use the unspecified code. You wouldn't be able to use the "specified type, NEC" diagnosis either because even though the location may be specified, the chronic/acute isn't documented so you do not know if the condition is, in fact, "not elsewhere classified". At this point, the physician can either add an addendum or correct the medical record and it can be coded accordingly or you would still just use the unspecified code but, of course, educate the provider(s) on the importance of distinguishing these conditions as acute or chronic! If you bring to their attention the amount of time (hence, money they just threw away paying you to research this!), and aggravate them enough, hopefully it will start to stick. I know I aggravate the daylights out of my providers, but when I sense them getting frustrated, I just tell them I don't make the rules and they can continue to "waste" money paying me to mull over said rules, or they can just type/dictate one extra little word!! Sometimes I will throw in that they are aggravating me more, lol, but that depends on how comfortable you are with them!
 
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