Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 16: Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of diseases of the musculoskeletal system and connective tissue and related procedures?

3. Chapter 13 of ICD-10-CM, Diseases of the Musculoskeletal System, M00–M99 Chapter 13 of ICD-10-CM includes categories M00–M99 are arranged in the following blocks: Infectious arthropathies Inflammatory polyarthropathies Osteoarthritis Other joint disorders Dentofacial anomalies Systemic connective tissue disorders

4. Chapter 13 of ICD-10-CM, Diseases of the Musculoskeletal System, M00–M99 Chapter 13 of ICD-10-CM includes categories M00–M99 are arranged in the following blocks: Deforming dorsopathies Spondylopathies Other dorsopathies Disorders of muscles Disorders of synovium and tendon Other soft tissue disorders Disorders of bone density and structure Other osteopathies

5. Chapter 13 of ICD-10-CM, Diseases of the Musculoskeletal System, M00–M99 Chapter 13 of ICD-10-CM codes include anatomic specificity and laterality Instructional notes indicate that additional codes should be assigned for associated conditions and that the underlying conditions should be coded first The type of osteoporosis including the site of a current pathological fracture is present in combination codes Some codes require the use of a seventh character to identify the episode of care such as initial encounter for fracture or subsequent episode of care

6. Coding Instructional Notes for ICD-10-CM Chapter 13 Chapter 13 begins with a note to “use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.” An Excludes2 notes identifies conditions that can be coded with codes in this chapter Certain arthropathies are due to microbiological agents Direct infection of a joint is defined as those where organisms invade synovial tissue and microbial antigen is present in the joint Indirect infection of a joint is one in which there is a reactive arthropathy or a postinfective arthropathy

7. Coding Instructional Notes for ICD-10-CM Chapter 13 Instructional notes explain how different codes are used, for example: M21.7 Unequal limb length (acquired) Note: The site used should correspond to the shorter limb Includes notes have also been used to define terms, for example: M70 Soft tissue disorders related to use, overuse and pressure Includes soft tissue disorders of occupational origin

8. Coding Guidelines for ICD-10-CM Chapter 13 Chapter-specific guidelines for Chapter 13 are included in the ICD-10-CM Official Guidelines for Coding and Reporting Guidelines address: Site and laterality Bone versus joint Acute traumatic versus chronic or recurrent musculoskeletal conditions Coding of pathologic fractures Osteoporosis with and without pathological fracture

9. Coding Diseases in ICD-10-CM Chapter 13 Chapter includes acute and chronic conditions of bone, joints, ligaments, muscles and intervertebral discs Most codes include the anatomic site and laterality The site indicates the bone, joint or muscle involved

10. Coding Diseases in ICD-10-CM Chapter 13 Seventh characters for stress fractures and pathological fractures require an appropriate seventh character to identify the episode of care, that include: A = initial encounter for the fracture D = subsequent encounter for fracture with routine healing G = subsequent encounter for fracture with delayed healing K = subsequent encounter for fracture with nonunion P = subsequent encounter for fracture with malunion S = sequela

11. Coding Diseases in ICD-10-CM Chapter 13 Two commonly used seventh characters are: Seventh character of A is used for patients receiving active treatment such as surgical treatment, emergency department encounter, and evaluation and management for a new physician Seventh character of D is used for encounters after the patient has completed active treatment such as cast change or removal, removal of external or internal fixation device, medication adjustment and other aftercare and follow-up visits

12. Coding Diseases in ICD-10-CM Chapter 13 Rheumatoid arthritis, a chronic crippling condition that affects the joints of hands, wrists, elbows, feet and ankles are classified to three categories: Rheumatoid arthritis with rheumatoid factor Other rheumatoid arthritis Juvenile arthritis Felty’s syndrome is rheumatoid arthritis with splenoadenomegaly and leukopenia Rheumatoid arthritis may also exist with rheumatoid lung disease

13. Coding Diseases in ICD-10-CM Chapter 13 Osteoarthritis is a disease of the joints that mainly affects the cartilage in the joint, more commonly in the hands, knees, hips and spine Polyosteoarthritis is arthritis of multiple sites that may be described as generalized arthritis or osteoarthritis Primary osteoarthritis is not caused by another disease but instead related to the aging process or unrecognized defects Secondary osteoarthritis is a degenerative disease of the joints that results from a predisposing factor, usually trauma, that damages the cartilage or subchondral bone of affected joints

14. Coding Diseases in ICD-10-CM Chapter 13 Systemic connective tissue disorders include autoimmune and collagen vascular disease Conditions coded to these categories include Polyarthritis nodosa and related conditions Other necrotizing vasculopathies Systemic lupus erythematous Dermatopolymyositis Systemic sclerosis or scleroderma Other systemic involvement of connective tissue

15. Coding Diseases in ICD-10-CM Chapter 13 Sysemic lupus erythematosus (SLE) is a chronic generalized connective tissue disorder ranging in severity marked by skin eruptions, arthralgia, fever, leukopenia, visceral lesions and other constitutional symptoms as well as many autoimmune phenomena There is another form of lupus that is not included in this chapter, that is, discoid lupus erythematosus which is a disease of the skin and subcutaneous tissue SLE conditions that involve endocarditis, pericarditis, lung and renal disease are identified at the fifth-character code level

16. Coding Diseases in ICD-10-CM Chapter 13 Codes for dorsopathies include deforming dorsopathies, spondylopathies and other dorsopathies that are specific to the regions of the cervical, thoracic, lumbar and sacral spine Deforming dorsopathies include: Kyphosis or a rounding or outward curve of the thoracic spine that may be described as hunchback Lordosis or an inward curvature of the lumbar spine which the abdomen appears to protrude Scoliosis is a sideways curvature of the spine upon imaging that appears as S-shaped or C-shaped

17. Coding Diseases in ICD-10-CM Chapter 13 Spondylopathy is a disease of the spinal vertebrae and includes: Ankylosis which is an abnormal immobility and fixation of a joint Spondylosis is an abnormal immobility and fixation of a vertebral joint Spondylosis is classified according to the region (cervical, thoracic, lumbar, lumbosacral) and whether or not it occurs with myelopathy or radiculopathy Another common spondylopathy is spinal stenosis Spinal stenosis is a narrowing of the spaces in between the vertebrae of the spine. This narrowing creates pressure on the spinal cord and the nerves which causes pain. Arthritis and scoliosis can cause spinal stenosis

18. Coding Diseases in ICD-10-CM Chapter 13 Compartment syndrome is a condition in which increased pressure is within an enclosed tissue space. There are two types: Traumatic and Nontraumatic Nontraumatic may also be called exertional compartment syndrome which is known to occur in individuals who exercise frequently, such as runners Nontraumatic compartment syndrome are coded to this chapters based on its location in the body, such as upper and lower extremity, abdomen and for other sites

19. Coding Diseases in ICD-10-CM Chapter 13 Osteoporosis is a metabolic bone disease where bones gradually lose protein structure and mineral content and eventually deteriorate. Category M80 is osteoporosis with current pathological fracture which may also be called current fragility fracture. These are combination codes that identify the type of osteoporosis and the site and laterality of the pathological fracture that is present. Sites of these types of fractures occur at the shoulder, humerus, forearm, hand, femur, lower leg, ankle or foot Seventh characters identify the episode of care

20. Coding Diseases in ICD-10-CM Chapter 13 Osteoporosis may occur with a malunion of a fracture which refers to a fracture that was reduced but the bone ends did not align properly during the healing process. Usually a malunion is diagnosed during the healing stages and requires surgical treatment A nonunion of a fracture is the failure of the bone ends to align or heal. This condition usually requires a reopening of the fracture site with some type of internal fixation and bone grafting

21. Coding Diseases in ICD-10-CM Chapter 13 Pathologic fractures and stress fractures are breaks in a bone as a result of disease or repetitive force. These are not traumatic fractures that are the result of an injury or trauma Pathologic fractures occur in existing diseases such as cancer of the bone and other conditions that are capable of weakening the bone Stress fractures occur when bones develop fatigue or stress from repetitive forces applied before the bone and its supporting structures have time to accommodate such force Seventh characters are required to identify the episode of care

22. Coding Diseases in ICD-10-CM Chapter 13 Osteomyelitis is an infection of the bone affecting the metaphyseal area of the long bones caused by bacteria, usually Staphylococcus aureus Codes for osteomyelitisare subdivided at the fourth-digit level to codes that describe acute, subacute, or chronic forms of the disease The fifth and sixth characters identify the bone involved and its laterality Two “use additional code” notes appear to identify the infectious agent or major osseous defect

23. Coding Procedures with ICD-10-PCS for Conditions in Chapter 13 Operations on the many parts of the musculoskeletal system are common procedures. Procedures are performed on bones, joints, muscles, tendons and ligaments See table 16.1 for the root operations for musculoskeletal procedures

24. Coding Procedures with ICD-10-PCS for Conditions in Chapter 13 Arthroscopic procedures use an arthroscope to see within a joint and perform surgical procedures on a joint When the arthroscopy is performed with no additional procedure performed in the joint, the root operation is “Inspection” When a more definitive procedure is performed through an arthroscope, only the definitive procedure is assigned using the root operation that identifies the objective of the procedures, for example, an excision

25. Coding Procedures with ICD-10-PCS for Conditions in Chapter 13 A joint replacement is the removal and replacement of a diseased joint with a device The root operation is “replacement” defined as putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part The hip joint replacement devices include metal, metal-on-polyethylene, ceramic and ceramic-on-polyethylene materials The only choice for a knee replacement device is synthetic substitute

26. Coding Procedures with ICD-10-PCS for Conditions in Chapter 13 For shoulder replacement devices, the choices are synthetic substitute with reverse ball and socket or simply synthetic substitute For both hip and knee replacement procedures, the seventh character (qualifier) identifies how the device is secured in place, for example, cemented or uncemented or not specified For shoulder joint replacements, the seventh character identifies the surface of the joint replace, that is, humeral surface, glenoid surface or not stated

27. Exercises Practice coding the conditions included in Chapter 13 of ICD-10-CM for diseases of the musculoskeletal system and connective tissue as well as the procedures used to treat these conditions by completing the review exercises for Chapter 16.