Coding corner update: Improve medical record documentation for musculoskeletal and connective tissues disease

Beginning Oct. 1, 2015, the transition to ICD-10-CM will affect every area of health care. Many codes contain much greater specificity. This article includes updated codes to align with the transition to ICD-10-CM.

Coding for musculoskeletal and connective tissues disease can be challenging. That’s why we’re providing some tips for the most common musculoskeletal and connective tissue diseases. Musculoskeletal and connective tissue diseases are classified in codes M00-M99 in the ICD-10-CM manual.

Lupus erythematosus
Lupus erythematosus is an autoimmune and chronic inflammatory disease that can affect many parts of the body, including skin, joints, kidneys, heart and lungs. The ICD-10-CM code category for systemic lupus is M32. Codes in this category include the organ or system involvement.

Rheumatoid arthritis
Considered a chronic condition, rheumatoid arthritis may be ascertained by reading a patient’s past medical history or by checking a problem list. Remember that joint pain or a diagnosis of arthritis is not considered rheumatoid arthritis.

According to the current American College of Rheumatology guidelines and clinical practice standards, patients with this condition require the initiation of disease-modifying anti-rheumatic drug therapy within three months of diagnosis. Accurate management and documentation are also important for HEDIS performance measurement purposes.

Chronic diseases, such as rheumatoid arthritis, which are treated on an ongoing basis, may be coded and reported as many times as the patient is receiving treatment and care for the condition. The ICD-10-CM code categories for rheumatoid arthritis include M05 and M06. Codes in these categories include specific sites and manifestations.

Osteoarthritis
The most common type of arthritis, osteoarthritis is a chronic joint disorder characterized by degeneration of joint cartilage and the adjacent bone. It usually occurs in the hands, knees, hip and spine. Osteoarthritis is also referred to as polyarthritis, degenerative joint disease, hypertrophic arthritis and degenerative arthritis. Osteoarthritis for most sites, excluding the spine, is assigned codes from categories M15 through M19. Osteoarthritis of the spine is termed spondylosis in ICD-10-CM and assigned to category M47.

• Generalized osteoarthritis (polyosteoarthritis) affects many joints and is assigned ICD-10-CM code M15.9. If it involves more than one site, but it’s not specified as generalized, code each site separately from codes in categories M16-M19. There are specific codes to identify whether the osteoarthritis is primary (M15.0), erosive (M15.4) or other type (M15.8).
• Localized osteoarthritis affects the joints of one site (unilateral or bilateral) and is further identified as either primary, secondary or post-traumatic in ICD-10-CM. Codes can be found in categories M16-M19.

  Primary: Generally occurs in individuals 55 or older and is associated with aging, affecting joints of one site (unilateral or bilateral) with no known cause (idiopathic).
  Secondary: Affects a joint of one site (unilateral or bilateral) and has a specific cause, such as an injury, another disease process, inactivity or genetics. ICD-10-CM has a separate category of codes for the reporting of post-traumatic osteoarthritis (M19.1-).

Sacroiliitis
This condition occurs when pain is caused by inflammation of the sacroiliac joint that attaches the sacrum to the pelvis. Sacroiliitis is often missed or inappropriately treated. Sacroiliitis can occur as a complication of infections in the heart, skin, joints or muscle. It also can follow a back injury. Many times, sacroiliac pain is mistaken for another cause of low back pain, such as a ruptured disk, collapsed vertebra, spinal stenosis or osteoarthritis of the joints in the spinal cord. Sacroiliitis may also be part of an inflammatory arthritic condition known as ankylosing spondylitis. For ankylosing spondylitis, the ICD-10-CM code category is M45; for sacroiliitis, use the code M46.1.

Osteoporosis
The most common bone disease, osteoporosis is a systemic condition affecting all bones and falls into two categories, primary and secondary.

• In ICD-10-CM there are two categories of osteoporosis codes: with or without a current pathological fracture:
• Age related including post-menopausal and senile. Use category M81.0 if no fracture present. Use category M80.8 if fracture present then code by site.
• Otherosteoporosis is generally caused by certain medical conditions, hormonal disorders, disuse or is drug-induced. Use category M81.0 if no fracture present. Use category M81.8 if fracture present then code by site. For drug-induced, use an additional ‘T’ code to identify the adverse effect of the drug, using 5th or 6th character of 5. Refer to the Official ICD-10-CM Guidelines for coding and reporting.

ICD coding for all conditions should follow coding conventions, chapter specific guidelines and general coding guidelines.

If you have questions or need more information, contact your provider consultant.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.