ICD-10-CM Coding Basics Chapter Specifics

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ICD-10-CM Coding Basics

Chapter Specifics

Vilma Smith, LVN, CPC, CCS

AHIMA Approved ICD-10-CM/PCS Trainer

Debra Bales, LVN, CPC

1

Chapter 13 Diseases of the Musculoskeletal System

and Connective Tissue

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ICD-10-CM Conventions

• General rules for use of the classification

independent of the guidelines.

• Conventions and instructions of the

classification takes precedence over

guidelines.

• Incorporated within the Alphabetic Index and

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ICD-10-CM Chapter Specifics

Chapter 13:

Diseases of the Musculoskeletal System and Connective Tissue(M00-M99)

• Largest number of documentation and coding changes

o Conditions affecting the cervical spine now require documenting the site as:

 _{Occipital-atlanto-axial, or high cervical region}  _{Mid-cervical region}

 Cervicothoracic region

• Condition affecting upper or lower end of the bone at the joint is designated to the bone site

not the joint

• Bone, joint or muscle conditions that are the result of a healed injury and are chronic or

recurrent conditions are usually found in the Musculoskeletal System Chapter (13)

• Specific documentation must be used to determine the differences of

Acute traumatic vs Chronic or Recurrent Musculoskeletal conditions :

o Acute traumatic conditions are coded under Chapter 19 (Injury, Poisoning, and Certain Other

Consequences of External Causes)

o Any current, acute injury should be coded to the appropriate injury code from Chapter 19.

o Many musculoskeletal conditions are results of a previous injury or trauma to a site, or are recurrent

conditions

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

Expansion for specified types of rheumatoid arthritis, complications of

lupus, organ and regional involvements:

• Rheumatoid Arthritis with rheumatoid factor (M05.-)

o Felty’s Syndrome (M05.0-)

o Rheumatoid lung disease with rheumatoid arthritis (M05.1-) o Rheumatoid vasculitis with rheumatoid arthritis (M05.2-) o Rheumatoid heart disease with rheumatoid arthritis (M05.3-) o Rheumatoid myopathy with rheumatoid arthritis (M05.4-)

o Rheumatoid polyneuropathy with rheumatoid arthritis (M05.5-)

o Rheumatoid arthritis with involvement of other organs and systems (M05.6-)

o Rheumatoid arthritis with rheumatoid factor without organ or systems involvement

(M05.7-)

o Other Rheumatoid arthritis with rheumatoid factor (M05.8-)

• Rheumatoid Arthritis

without rheumatoid factor

(M06.0-)

o Rheumatoid Arthritis without rheumatoid factor, vertebrae (M06.08) o Rheumatoid Arthritis without rheumatoid factor, multiple sites (M06.09)

• Document

site

involved - (Right or Left - Shoulder, Elbow, Wrist, Hand, Hip,

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

• Other Rheumatoid Arthritis (M06.-)

o Adult-onset Still’s disease (M06.1) o Rheumatoid bursitis (M06.2-)

 Document site involved - (Right or Left Shoulder, Elbow, Wrist, Hand, Hip, Knee, Ankle

and Foot)

 Rheumatoid bursitis, vertebrae (M06.28)  Rheumatoid bursitis, multiple sites (M06.29)

o Rheumatoid nodule (M06.3-)

 Document site involved - (Right or Left Shoulder, Elbow, Wrist, Hand, Hip, Knee, Ankle

and Foot)

 Rheumatoid nodule, vertebrae (M06.28)  Rheumatoid nodule, multiple sites (M06.29)

• Other specified rheumatoid Arthritis (M06.8-)

o Document site involved - (Right or Left Shoulder, Elbow, Wrist, Hand, Hip, Knee, Ankle and Foot)

o Other specified rheumatoid Arthritis, vertebrae (M06.88) o Other specified rheumatoid Arthritis, multiple sites (M06.89)

• Rheumatoid arthritis, unspecified (M06.9)

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

• Enteropathic Arthropathies (M07.-)

o

Document

site

involved - (Right or Left Shoulder, Elbow, Wrist, Hand, Hip,

Knee, Ankle and Foot, Vertebrae, Multiple sites)

• Juvenile Arthritis (M08.-)

o

Document

site

involved - (Right or Left Shoulder, Elbow, Wrist, Hand, Hip,

Knee, Ankle and Foot, Vertebrae, Multiple sites)

o

Unspecified juvenile rheumatoid arthritis (M08.0)

o

Juvenile rheumatoid arthritis with systemic onset (M08.2-)

o

Pauciarticular juvenile rheumatoid arthritis (M08.4-)

o

Other juvenile arthritis (M08.8-)

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

Systemic Lupus Erythematosus (SLE) M32.-

• Drug-induced systemic lupus erythematosus M32.0

o Use additional code for adverse effect, if applicable to identify drug (T36-T50 with fifth or sixth

character 5)

• SLE with organ or system involvement (M32.1-)

o Endocarditis in Systemic Lupus Erythematosus M32.11 o Pericarditis in Systemic Lupus Erythematosus M32.12

o Lung involvement in Systemic Lupus Erythematosus M32.13 o Glomerular disease in Systemic Lupus Erythematosus M32.14

o Tubulo-interstitial nephropathy in Systemic Lupus Erythematosus M32.15 o Other forms of SLE (M32.8)

o Systemic Lupus Erythematosus (SLE), unspecified (M32.9)

• Systemic Sclerosis [scleroderma] M34.-

o Progressive systemic sclerosis M34.0 o CR(E)ST syndrome M34.1

o Systemic sclerosis induced by drug and chemical M34.2

 Code first poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4 or 6)

 Use additional code for adverse effect, if applicable to identify drug (T36-T50 with fifth or sixth character 5)

 Other forms of systemic sclerosis

 Systemic sclerosis with lung involvement M34.81

 Systemic sclerosis with myopathy M34.82

 Systemic sclerosis with polyneuropathy M34.83

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

• Seventh (7

th

) characters for chronic gout (M1A.-)

o

0 - without tophus (tophi)

o

1 - with tophus (tophi)

Example:

Idiopathic chronic gout, right ankle and foot, without tophus - M1A.0710

• Seventh (7

th

) characters for stress and pathological fracture (M80, M84.3 - M84.6)

o

A - initial encounter for fracture

o

D - subsequent encounter for fracture with routine healing

o

G - subsequent encounter for fracture with delayed healing

o

K - subsequent encounter for fracture with nonunion

o

P - subsequent encounter for fracture with malunion

o

S – sequela

Example:

Age-related osteoporosis with current pathological fracture, vertebrae,

initial encounter for fracture - M80.08XA

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

Intervertebral Disc Disorders

• Identify condition:

o Disc disorder with myelopathy o Disc disorder with radiculopathy

o Other disc displacement *use this for the specified condition when no documentation or either

myelopathy or radiculopathy.

o Other disc degeneration *use this for the specified condition when no documentation or either

o Other disc disorders *use this for the specified condition when no documentation or either

o Schmorl’s nodes (M51.4-)

• Identify site:

o Cervical (M50.-)

 High cervical region

 Mid-cervical region

 Cervicothoracic region

 Unspecified cervical region

o Thoracic region (M51.-) o Thoracolumbar region o Lumbar region (M51.-) o Lumbosacral region

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

Low Back Pain (M54.5)/Sciatica (M54.3-)

• Identify the low back pain/sciatica

o With sciatica (M54.4-)

 Right side

 Left side

o Without sciatica (M54.5)

Osteoporosis (M80.- ; M81.-)

• Identify osteoporosis as with or without current pathological fracture

• Identify type /cause of osteoporosis

o Age-related o Localized

o Bone depleting medications

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ICD-10-CM Chapter Specifics

Chapter 13: (cont.)

Osteoporosis with current pathological fracture (M80.-)

• Document

type

of Osteoporosis:

o Age-related osteoporosis o Drug-induced o Idiopathic o Osteoporosis of disuse o Postoophorectomy osteoporosis o Postsurgical malabsorption o Post-traumatic osteoporosis

• Identify

site

of pathological fracture:

o Shoulder o Humerus o Forearm o Hand o Femur o Lower Leg o Ankle/foot o Vertebra(e)

• Document episode of care (7

th