Clean Up Diagnosis Coding For Staged Revisions
Assigning diagnosis codes for joint revision surgery is challenging in both ICD-9-CM and ICD-10-CM. Orthopaedic practices that carefully examine the instructions in both editions may find that they have been reporting staged revisions incorrectly for years. The following side-by-side comparison of ICD-9 and ICD-10 coding will help clean up diagnosis coding for staged revision surgeries.
Lets start with the diagnosis coding for the initial surgerya right total knee replacement for primary osteoarthritis. In ICD-9-CM, the diagnosis code is 715.16 . In ICD-10-CM, the code is M17.11 . Although both ICD-9 and ICD-10 require that the etiology of the osteoarthritis be documented, ICD-10 also requires that laterality be specified.
Staged revision, part 1One year later, the same patient returns, reporting pain, swelling, warmth, and a large effusion of 3 months duration. Radiographs show radiolucency beneath the femoral and tibial components, and a joint aspiration culture reveals the presence of Staphylococcus epidermidis. A staged revision of the implant is scheduled. The plan includes removal of the prosthesis and insertion of an antibiotic cement spacer, followed by 6 weeks of intravenous antibiotics and monitoring of serum C reactive protein and erythrocyte sedimentation rate before a new prosthesis is implanted.
The diagnosis codes for the first of this two-stage procedure are as follows:
ICD-9-CM
ICD-10-CM
ICD-9-CM
ICD-10-CM
What Is Knee Osteoarthritis
Osteoarthritis. Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative,wear-and-tear type of arthritis that occurs most often in people 50 years of age and older, although it may occur in younger people, too. In osteoarthritis, the cartilage in the knee joint gradually wears away.
Basics About Osteoarthritis Icd 10 Code
Osteoarthritis is a joint disease caused by aging, injury or obesity. The most common symptoms for osteoarthritis are joint pain and stiffness. Therefore, coding Osteoarthritis is not much different from coding joint pain. I have already shared how we have code ICD 10 CM code for Knee pain in my previous post. As I have mentioned earlier, the ICD 10 code varies for each joint, so let us first checkout the different ICD 9 CM for Osteoarthritis of each joint.
715.91 shoulder
715.95 Pelvic region and thigh
715.96 Lower leg
715.97 ankle and foot
715.90 site, unspecified
Now, the above list of ICD 9 codes for osteoarthritis is to be used only when they have documented osteoarthritis. There are similar ICD 9 codes for localized and generalized osteoarthritis, which should be used only when there is clear documentation of localized and generalized osteoarthritis of joint.
Read also: Learn about the difference between Excludes 1 and Excludes 2 in ICD 10
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Diagnosis Frequency By Condition Grouping
The most common group of conditions across all diagnoses was Spinal Conditions , followed by Peripheral Joint Disorders , Connective/Soft Tissue Disorders , and Osteoarthritis . For all condition groupings, a negative exponential distribution described the pattern of code use across all codes used, with very few codes having exceptionally frequent use within each grouping. For example, âLow back painâ andâCervicalgiaâ accounted for 61.4% of all Spinal Disorders diagnoses, with a rapid drop-off in frequency beyond these two codes. Joint Disorders demonstrated a more gradual decrease across the five most common codes , followed by a rapid decrease beyond these codes. All groupings reached a âsteady stateâ of less than 1% of code use in each grouping between the tenth and twenty-third most common M-codes.
Unilateral Primary Osteoarthritis Right Knee
- 20162017201820192020202120222023Billable/Specific Code
- M17.11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- The 2023 edition of ICD-10-CM M17.11 became effective on October 1, 2022.
- This is the American ICD-10-CM version of M17.11 – other international versions of ICD-10 M17.11 may differ.
- Applicable To annotations, or
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M179 Osteoarthritis Of Knee Unspecified
NEC Not elsewhere classifiableThis abbreviation in the Tabular List represents other specified. When a specific code is not available for a condition, the Tabular List includes an NEC entry under a code to identify the code as the other specified code.
NOS Not otherwise specifiedThis abbreviation is the equivalent of unspecified.
This note further define, or give examples of, the content of the code or category.
List of terms is included under some codes. These terms are the conditions for which that code is to be used.The terms may be synonyms of the code title, or, in the case of other specified codes, the terms are a list of the various conditions assigned to that code.The inclusion terms are not necessarily exhaustive. Additional terms found only in the may also be assigned to a code.
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation.Wherever such a combination exists, there is a use additional code note at the etiology code, and a code first note at the manifestation code.These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
What Is The Cpt Code For Right Knee
CPT code 29877 is included with CPT code 29881 and 29880 when performed on same knee. However, if the procedures are performed on different knee, for example Chondroplasty is performed on left knee and meniscectomy is performed on right knee in such cases we can code them together using 59 modifier.
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Diagnosis Frequency By Visit Diagnosis And Unique Patient
Of the more than 6,400 ICD-10 M-code diagnoses available, 5,723 were used at least once. Over the 2-year study period, 61% of codes used were used fewer than 100 times and 28% were used fewer than 10 times across all approximately 31 million musculoskeletal diagnoses. âLow Back Painâ was the most frequently used diagnostic code across all M-coded visit diagnoses, followed by âCervicalgiaâ .
The 10 most common diagnoses, by visit and by patient, are presented in Table 2. The most common diagnoses were generally consistent across visits and patients. Low back pain, neck pain, knee pain, shoulder pain, gout, and osteoarthritis were the most common diagnoses, both by visit and by patient. âGeneralized Muscle Weaknessâ was the fifth most common diagnosis by M-coded visit diagnoses but was the twelfth most common diagnosis by patient . âUnspecified Osteoarthritis, Unspecified Siteâ was the ninth most common diagnosis by patient and the twelfth most common diagnosis by visit . Frequency of use for each of the 100 most common M-code diagnoses, both individually and as a cumulative sum, are presented in Supplementary Data Table 1.
Tools For Optimized Coding
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Unilateral Primary Osteoarthritis Of Knee
- 20162017201820192020202120222023Non-Billable/Non-Specific Code
- Arthritis of right knee
- Osteoarthritis of right knee patellofemoral joint
- Osteoarthritis of right patellofemoral joints
- Primary localized osteoarthritis of right knee
- Primary osteoarthritis of right knee
M17.11 Unilateral primary osteoarthritis, right knee
Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.
What Is The Diagnosis For Knee Osteoarthritis
ICD-10-CM Code M17 Osteoarthritis of knee NON-BILLABLE | ICD-10 from 2011 2016 ICD Code M17 is a non-billable code. To code a diagnosis of this type, you must use one of the seven child codes of M17 that describes the diagnosis osteoarthritis of knee in more detail. M17 Osteoarthritis of knee M17.0 Bilateral primary osteoarthritis of knee
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Capturing Patient Journeys: Icd
Total knee replacement surgery is one of the most common major orthopedic procedures performed today. And, as part of the patient care team, skilled and talented coders and billers use ICD-10 codes to capture these TKR patients journeys.
More than 600,000 total knee replacement surgeries are performed each year in the U.S., a number that is expected to increase to 1,272,000 by 2025.1 As these numbers grow, physical therapy continues to be an integral part of patient journeys.
From the time patients identify pain and mobility issues to seeking non-surgical treatment, diagnosis insight, as well as pre- and post-op knee replacement treatment, ICD-10 codes track their care. They allow both small and large physical therapy clinics to follow patients from knee pain, through surgery, and into rehab and the road to optimal function and mobility.
In addition, billers and coders endeavor to optimize claim reimbursements with ICD-10 and strive to utilize tools that encourage positive patient engagement in our physical therapy clinics.
At the same time, efficient and successful ICD-10 tools create opportunities for excellent staff retention.
Streamline Revenue With Coding Automation
Effective ICD-10 coding tools help successfully process knee replacement physical therapy billing.
A growth industry, the global joint replacement market size was valued at $17.1 billion in 20202, with the largest revenue share of 46% in knee joint replacement. Due to an aging population and the prevalence of osteoporosis and rheumatoid arthritis, the global joint replacement market size is expected to grow by a of 3.4% from 2021 to 2028.
Notably, chronic pain after TKR is experienced by approximately 20% of patients3. This may negatively impact the patients quality of life, function and mobility.
Physical therapy following total knee replacement surgery is an identified recommended treatment protocol for improving postsurgical outcomes.4 Using a highly customizable and tailored outpatient physical therapy EMR and billing software can streamline billing processes and improve reimbursement.
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What Is The Icd 10 Code For Right Knee Osteoarthritis
M17.11, unilateral primary osteoarthritis, right knee.
What is the ICD 10 code for bilateral OA of knees?
2022 ICD-10-CM Diagnosis Code M17.0: Bilateral primary osteoarthritis of knee.
What is unilateral primary osteoarthritis right knee?
Some people get OA in just one knee, which is known as unilateral OA. Bilateral knee arthritis occurs when both knees are affected with OA. OA is a painful, degenerative condition that can reduce your mobility and make daily tasks difficult to manage.
What is CPT code for knee osteoarthritis?
Generalized osteoarthritis affects many joints, while localized osteoarthritis affects the joints of one site.
What is the ICD code for osteoarthritis?
ICD-10 code M19.90 for Unspecified osteoarthritis, unspecified site is a medical classification as listed by WHO under the range Arthropathies .
Diseases Of The Musculoskeletal System And Connective Tissuenote
- certain conditions originating in the perinatal period
- certain infectious and parasitic diseases
- compartment syndrome
- complications of pregnancy, childbirth and the puerperium
- congenital malformations, deformations, and chromosomal abnormalities
- endocrine, nutritional and metabolic diseases
- injury, poisoning and certain other consequences of external causes
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
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What Is Unspecified Osteoarthritis
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of the bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine.
Osteoarthritis Of Knee Unspecified
- 20162017201820192020202120222023Billable/Specific Code
- M17.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- The 2023 edition of ICD-10-CM M17.9 became effective on October 1, 2022.
- This is the American ICD-10-CM version of M17.9 – other international versions of ICD-10 M17.9 may differ.
- Applicable To annotations, or
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Documentation For Icd 10 Code For Osteoarthritis
The documentation can have different names for osteoarthritis in the medical report. I being a medical coder, have come across phrases like degenerative changes of joint, degenerative joint disease, tricompartmental osteoarthritis, OA disease etc. which will be documented in the medical report to denote osteoarthritis. Hence, you should be careful while coding osteoarthritis ICD 10 CM code.
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Varus Deformity Not Elsewhere Classified Unspecified Knee
- 20162017201820192020202120222023Billable/Specific Code
- M21.169 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- The 2023 edition of ICD-10-CM M21.169 became effective on October 1, 2022.
- This is the American ICD-10-CM version of M21.169 – other international versions of ICD-10 M21.169 may differ.
- Applicable To annotations, or
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What Is Severe Osteoarthritis Of The Knee
OA of the knee is a progressive condition in which cartilage breaks down around the bones in a joint. As time goes on, the bones will start to rub together, and bone spurs can develop. There will be increasing levels of pain and stiffness and possibly a loss of mobility. Various treatment options can help manage OA.
Varus Deformity Not Elsewhere Classified Knee
- 20162017201820192020202120222023Non-Billable/Non-Specific Code
- Acquired genu varum
- 564 Other musculoskeletal system and connective tissue diagnoses with mcc
- 565 Other musculoskeletal system and connective tissue diagnoses with cc
- 566 Other musculoskeletal system and connective tissue diagnoses without cc/mcc
M21.169 Varus deformity, not elsewhere classified, unspecified knee
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