The Centers for Medicare & Medicaid Services (“CMS”) recently introduced the ICD-10 Clinical Concepts Series to help healthcare providers adopt ICD-10 diagnosis codes comprehensively. We have listed a few major diseases, clinical concepts, and the ICD-10 coding range.
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Following are the orthopedics diseases and their ICD-10 codes:
(ICD-9-CM 722.0, 722.4, 722.71, 722.91, 723.4)
Cervical spine disorders involve the neck bones (vertebrae), and spongy discs between the vertebrae, joints, muscles, and ligaments. The major causes of cervical spine disorders include; injury or degeneration (breakdown) of the structures in the spine from normal “wear and tear”, stress, smoking, or aging.
The main symptom of a cervical spine disorder is characterized by “neck pain”. You may also have pain in the head, jaw, shoulders, arms, or legs, as well as numbness and weakness. Other problems include impaired coordination or balance, difficulty breathing, or loss of bowel and bladder control.
The following are common cervical spine disorders:
Cervical spondylosis: Cartilage and vertebrae wear out abnormally
Cervical herniated disc: Discs between the vertebrae rupture, protrude, or bulge out
Degenerative disc disease: Discs between the vertebrae break down
Cervical spinal stenosis: Spinal canal narrows around the spinal cord
Cervical myelopathy: Spinal cord damage caused by stenosis or degeneration
Cervical radiculopathy: Pinched nerve or compression
Following ICD-10-CM codes are used for the different cervical spine disorders:
M50.22 Other cervical disc displacement, mid-cervical region
M50.23 Other cervical disc displacement, cervicothoracic region
M50.30* Other cervical disc degeneration, unspecified cervical region
M50.31 Other cervical disc degeneration, occipito-atlanto-axial region
M50.32 Other cervical disc degeneration, mid-cervical region
M50.33 Other cervical disc degeneration, cervicothoracic region
M50.80* Other cervical disc disorders, unspecified cervical region
M50.81 Other cervical disc disorders, occipito-atlanto-axial region
M50.82 Other cervical disc disorders, mid-cervical region
M50.83 Other cervical disc disorders, cervicothoracic region
M50.90* Cervical disc disorder, unspecified, unspecified cervical region
M50.91 Cervical disc disorder, unspecified, occipito-atlanto-axial region
M50.92 Cervical disc disorder, unspecified, mid-cervical region
M50.93 Cervical disc disorder, unspecified, cervicothoracic region
(ICD-9-CM 723.1, 724.1, 724.2, 724.3, 724.5)
The most common cause of neck and back pain is muscle injury in which muscles stretch to an extreme level and tear. Moreover, poor body posture, strenuous activity, heavy lifting, and repetitive motion can cause permanent neck and back pain.
Following are the ICD-10-CM codes used to indicate the diagnosis procedures of neck and back pain.
M54.2 Cervicalgia
M54.30* Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.40* Lumbago with sciatica, unspecified side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M54.5 Low back pain
M54.6 Pain in thoracic spine
M54.89 Other dorsalgia
M54.9* Dorsalgia, unspecified
(ICD-9-CM 715.15, 715.25, 715.35, 715.95)
It is a noninflammatory degenerative disease of the hip joint that usually appears in middle or old age. Osteoarthritis of the hips is characterized by growth or maturational disturbances in the femoral neck and head as well as acetabular dysplasia. The primary symptom of this disease is characterized by pain on weight-bearing or motion.
M16 is a non-billable ICD-10-CM code for osteoarthritis of the hip that should not be used for reimbursement purposes because there are other codes under ICD-10-CM M16 that provide more details. The 2023 edition of ICD-10-CM became effective on October 1, 2022. It is the American version of M16 which could be different from the international version of this code.
Following are the ICD-10-CM codes used for different diagnostic procedures.
M16.0 Bilateral primary osteoarthritis of hip
M16.10* Unilateral primary osteoarthritis, unspecified hip
M16.11 Unilateral primary osteoarthritis, right hip
M16.12 Unilateral primary osteoarthritis, left hip
M16.2 Bilateral osteoarthritis resulting from hip dysplasia
M16.30* Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip
M16.31 Unilateral osteoarthritis resulting from hip dysplasia, right hip
M16.32 Unilateral osteoarthritis resulting from hip dysplasia, left hip
M16.4 Bilateral post-traumatic osteoarthritis of hip
M16.50* Unilateral post-traumatic osteoarthritis, unspecified hip
M16.51 Unilateral post-traumatic osteoarthritis, right hip
M16.52 Unilateral post-traumatic osteoarthritis, left hip
M16.6 Other bilateral secondary osteoarthritis of hip
M16.7 Other unilateral secondary osteoarthritis of hip
M16.9* Osteoarthritis of hip, unspecified
(ICD-9-CM 715.16, 715.26, 715.36, 715.96)
Osteoarthritis of the knee is the disease when the cartilage in your knee joint breaks down enabling the bones to rub together. This friction causes pain in your knees, make them stiff, and sometimes triggers swelling.
There is no cure for osteoarthritis in the knee, however, there are many treatments that can slow down the progress of this disease and ease your symptoms.
M17 is a non-billable ICD-10-CM code that can’t be used for reimbursement purposes because there are other highly specific codes under M17 that provide greater details as follows;
M17.0 Bilateral primary osteoarthritis of knee
M17.10* Unilateral primary osteoarthritis, unspecified knee
M17.11 Unilateral primary osteoarthritis, right knee
M17.12 Unilateral primary osteoarthritis, left knee
M17.2 Bilateral post-traumatic osteoarthritis of knee
M17.30* Unilateral post-traumatic osteoarthritis, unspecified knee
M17.31 Unilateral post-traumatic osteoarthritis, right knee
M17.32 Unilateral post-traumatic osteoarthritis, left knee
M17.4 Other bilateral secondary osteoarthritis of knee
M17.5 Other unilateral secondary osteoarthritis of knee
M17.9* Osteoarthritis of knee, unspecified
(ICD-9-CM 723.4, 724.3, 724.4, 729.2)
Radiculopathy is also referred to as a pinched nerve that is caused due to an injury or damage to nerve roots in the area where they leave spice. This condition can affect anyone and can cause disc degeneration, disc herniation or other trauma. Reportedly, around 46% of people will develop radiculopathy in their life.
Types of Radiculopathy
Radiculopathy is categorized into three classifications:
Following are the ICD-10-CM codes for radiculopathy. The 2023 edition of these codes became effective on October 1, 2022. It is the American version of these codes which could be different from the international version of them.
M54.10* Radiculopathy, site unspecified
M54.11 Radiculopathy, occipito-atlanto-axial region
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.30* Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
(ICD-9-CM 714.0, 714.2)
Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease which means that it makes your immune system attack healthy cells in your body which cause inflammation (painful swelling) in the affected parts of your body.
Usually, this disease affects many joints at once. Most commonly it affects the joints in the hands, wrists, and knees. Joints that are affected by rheumatoid arthritis become inflamed which further causes damage to joint tissues. The damaged joint tissues cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).
Along with joint tissues, RA can cause damage to other tissues and organs in the body as well i.e. lungs, eyes, and heart.
M05 is the ICD-10-CM code of Rheumatoid arthritis with rheumatoid factor. It is a non-billable/non-reimbursable code because there are other codes under M05 that provide more details about the specificity of the diagnoses of several symptoms of RA.
M05 excludes Combination Codes that Include Neuropathy, Bursitis, and Nodule Codes, and the Codes that Indicate “Unspecified Site”.
Following are the ICD-10-CM codes for rheumatoid arthritis. The 2023 edition of these codes became effective on October 1, 2022. It is the American version of these codes which could be different from the international version of these codes.
M05.611 Rheumatoid arthritis of right shoulder with involvement of other organs and systems
M05.612 Rheumatoid arthritis of left shoulder with involvement of other organs and systems
M05.619* Rheumatoid arthritis of unspecified shoulder with involvement of other organs and systems
M05.621 Rheumatoid arthritis of right elbow with involvement of other organs and systems
M05.622 Rheumatoid arthritis of left elbow with involvement of other organs and systems
M05.629* Rheumatoid arthritis of unspecified elbow with involvement of other organs and systems
M05.631 Rheumatoid arthritis of right wrist with involvement of other organs and systems
M05.632 Rheumatoid arthritis of left wrist with involvement of other organs and systems
M05.639* Rheumatoid arthritis of unspecified wrist with involvement of other organs and systems
M05.641 Rheumatoid arthritis of right hand with involvement of other organs and systems
M05.642 Rheumatoid arthritis of left hand with involvement of other organs and systems
M05.649* Rheumatoid arthritis of unspecified hand with involvement of other organs and systems
M05.651 Rheumatoid arthritis of right hip with involvement of other organs and systems
M05.652 Rheumatoid arthritis of left hip with involvement of other organs and systems
M05.659* Rheumatoid arthritis of unspecified hip with involvement of other organs and systems
M05.661 Rheumatoid arthritis of right knee with involvement of other organs and systems
M05.662 Rheumatoid arthritis of left knee with involvement of other organs and systems
M05.669* Rheumatoid arthritis of unspecified knee with involvement of other organs and systems
M05.671 Rheumatoid arthritis of right ankle and foot with involvement of other organs and systems
M05.672 Rheumatoid arthritis of left ankle and foot with involvement of other organs and systems
M05.679* Rheumatoid arthritis of unspecified ankle and foot with involvement of other organs and systems
M05.69 Rheumatoid arthritis of multiple sites with involvement of other organs and systems
M05.711 Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement
M05.712 Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement
M05.719* Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement
M05.721 Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement
M05.722 Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement
M05.729* Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement
M05.731 Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement
M05.732 Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement
M05.739* Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement
M05.741 Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement
M05.742 Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement
M05.749* Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement
M05.751 Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement
M05.752 Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement
M05.759* Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.769* Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement
M05.771 Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement
M05.772 Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement
M05.779* Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement
M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
M05.811 Other rheumatoid arthritis with rheumatoid factor of right shoulder
M05.812 Other rheumatoid arthritis with rheumatoid factor of left shoulder
M05.819* Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder
M05.821 Other rheumatoid arthritis with rheumatoid factor of right elbow
M05.822 Other rheumatoid arthritis with rheumatoid factor of left elbow
M05.829* Other rheumatoid arthritis with rheumatoid factor of unspecified elbow
M05.831 Other rheumatoid arthritis with rheumatoid factor of right wrist
M05.832 Other rheumatoid arthritis with rheumatoid factor of left wrist
M05.839* Other rheumatoid arthritis with rheumatoid factor of unspecified wrist
M05.841 Other rheumatoid arthritis with rheumatoid factor of right hand
M05.842 Other rheumatoid arthritis with rheumatoid factor of left hand
M05.849* Other rheumatoid arthritis with rheumatoid factor of unspecified hand
M05.851 Other rheumatoid arthritis with rheumatoid factor of right hip
M05.852 Other rheumatoid arthritis with rheumatoid factor of left hip
M05.859* Other rheumatoid arthritis with rheumatoid factor of unspecified hip
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M05.869* Other rheumatoid arthritis with rheumatoid factor of unspecified knee
M05.871 Other rheumatoid arthritis with rheumatoid factor of right ankle and foot
M05.872 Other rheumatoid arthritis with rheumatoid factor of left ankle and foot
M05.879* Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot
M05.89 Other rheumatoid arthritis with rheumatoid factor of multiple sites
M05.9* Rheumatoid arthritis with rheumatoid factor, unspecified
M06.00* Rheumatoid arthritis without rheumatoid factor, unspecified site
M06.011 Rheumatoid arthritis without rheumatoid factor, right shoulder
M06.012 Rheumatoid arthritis without rheumatoid factor, left shoulder
M06.019* Rheumatoid arthritis without rheumatoid factor, unspecified shoulder
M06.021 Rheumatoid arthritis without rheumatoid factor, right elbow
M06.022 Rheumatoid arthritis without rheumatoid factor, left elbow
M06.029* Rheumatoid arthritis without rheumatoid factor, unspecified elbow
M06.031 Rheumatoid arthritis without rheumatoid factor, right wrist
M06.032 Rheumatoid arthritis without rheumatoid factor, left wrist
M06.039* Rheumatoid arthritis without rheumatoid factor, unspecified wrist
M06.041 Rheumatoid arthritis without rheumatoid factor, right hand
M06.042 Rheumatoid arthritis without rheumatoid factor, left hand
M06.049* Rheumatoid arthritis without rheumatoid factor, unspecified hand
M06.051 Rheumatoid arthritis without rheumatoid factor, right hip
M06.052 Rheumatoid arthritis without rheumatoid factor, left hip
M06.059* Rheumatoid arthritis without rheumatoid factor, unspecified hip
M06.061 Rheumatoid arthritis without rheumatoid factor, right knee
M06.062 Rheumatoid arthritis without rheumatoid factor, left knee
M06.069* Rheumatoid arthritis without rheumatoid factor, unspecified knee
M06.071 Rheumatoid arthritis without rheumatoid factor, right ankle and foot
M06.072 Rheumatoid arthritis without rheumatoid factor, left ankle and foot
M06.079* Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot
M06.08 Rheumatoid arthritis without rheumatoid factor, vertebrae
M06.09 Rheumatoid arthritis without rheumatoid factor, multiple sites
M06.80* Other specified rheumatoid arthritis, unspecified site
M06.811 Other specified rheumatoid arthritis, right shoulder
M06.812 Other specified rheumatoid arthritis, left shoulder
M06.819* Other specified rheumatoid arthritis, unspecified shoulder
M06.821 Other specified rheumatoid arthritis, right elbow
M06.822 Other specified rheumatoid arthritis, left elbow
M06.829* Other specified rheumatoid arthritis, unspecified elbow
M06.831 Other specified rheumatoid arthritis, right wrist
M06.832 Other specified rheumatoid arthritis, left wrist
M06.839* Other specified rheumatoid arthritis, unspecified wrist
M06.841 Other specified rheumatoid arthritis, right hand
M06.842 Other specified rheumatoid arthritis, left hand
M06.849* Other specified rheumatoid arthritis, unspecified hand
M06.851 Other specified rheumatoid arthritis, right hip
M06.852 Other specified rheumatoid arthritis, left hip
M06.859* Other specified rheumatoid arthritis, unspecified hip
M06.861 Other specified rheumatoid arthritis, right knee
M06.862 Other specified rheumatoid arthritis, left knee
M06.869* Other specified rheumatoid arthritis, unspecified knee
M06.871 Other specified rheumatoid arthritis, right ankle and foot
M06.872 Other specified rheumatoid arthritis, left ankle and foot
M06.879* Other specified rheumatoid arthritis, unspecified ankle and foot
M06.88 Other specified rheumatoid arthritis, vertebrae
M06.89 Other specified rheumatoid arthritis, multiple sites
M06.9* Rheumatoid arthritis, unspecified
It is important to get expertise in medical coding to get paid for orthopedic care services. If proper attention is not delivered to the coding procedures then it leads to huge fines and legal consequences as well. Orthopedic medical coding specialists and healthcare providers should get well-versed in the nuances of bundled, and non-bundled codes, the difference between the coding of new and established patients, and applying accurate codes according to the different levels of E/M services.
If you’re unfamiliar with these terms, then read out the following orthopedic medical coding guidelines to make your orthopedic medical billing services error-free and reduce the number of claim denials for your practice.
When a payer combines two or more codes into one then it is called a bundling package. A bundle package helps medical care providers to get paid for multiple procedures (that are delivered in the same encounter) under one dominant code.
For example, if a patient visits an orthopedist's office with a nosebleed and the physician performs a diagnostic nasal endoscopy (31231), then the practitioners won’t code the cautery of the nosebleed (30903) and the endoscopy separately. Instead, this case will be handled with a single code because eliminating the bleeding is a given part of the endoscopy procedure.
In the other case, when the orthopedic doctor first performs the nasal endoscopy during a 9 AM appointment. At 2 PM, the same patient returns and shows up with a nosebleed asking for treatment.
In such cases, the provider should add a modifier i.e. 59 for “distinct procedural service” to the cauterization code and put both codes on your claim.
Using “59” is the only way to unbundle codes for the services delivered in the different encounters. This modifier indicates to the payer that the procedures are executed separately and a practitioner should get paid for both of them.
Following are the bundled orthopedic procedures:
29881 – medial OR lateral meniscectomy is obviously included with medial AND lateral.
28982 – medial OR lateral meniscal repair cannot be reimbursed when you have performed a meniscectomy.
28983 – medial AND lateral meniscal repair cannot be reimbursed when you have performed a meniscectomy.
ICD-10-CM codes are also used to re-document or reference extensive details around the circumstances of the injury. If an orthopedic medical coding specialist notes down all the details then he’ll be able to ensure accurate medical coding and process error-free claims.
The details of the circumstances of injury include timeframe, etiology, episode of care, injury site, cause, and place of occurrence. According to the guidelines of ICD-10-CM, place of occurrence, activity, and work status are only encoded on the first patient’s visit.
After that medical coders should assign the appropriate 7th character (initial encounter, subsequent encounter, or sequelae e.g. V83.7xxD for V83.7xxD, the person outside of a special industrial vehicle injured in a nontraffic accident ) for every subsequent encounter for the treatment of the same injury.
Moreover, the guidelines reflect that there is no national requirement that mandates ICD-10-CM external cause code reporting. However, you may be required to report them based on a state-based external cause code mandate e.g. for a trauma registry or as required by a particular payer.
Therefore, providers are encouraged to voluntarily report external cause codes as they provide useful information for injury research and assist in claim processing/ insurance coordination of benefits.
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