Os acromiale vs shoulder impingement
I would like to suggest that when shoulder impingemet (ICD-9 726.2) is stated to be due to a primary process like os acromiale, or if os acromiale is the sole problem without impingement, that a code for os acromiale should be reported.
What is os acromiale:
"Os acromiale, the joining of the acromion to the scapular spine by fibrocartilaginous tissue rather than bone, is an anatomic variant that has been reported in approximately 8% of the population worldwide."
Since this is an anatomic variant (=born with it) and not secondary to some other condition like trauma, it should be reported using a code from the congenital anomaly section of ICD9. There is no specific code for this, so I suggest
ICD-9 755.59: Other congenital anomaly of upper limb, including shoulder girdle
If there are other documented conditions like impingement, then code them.
BUT MOST OS ACROMIALE IS ASSYMPTOMATIC. So I strongly disagree with reporting os acromiale using the code for impingement, ICD-9 726.2, if there is no documentation of impingement.
Scott Freathy, MD, CPC