icd-10-cm codes m00-m99 icd-10-cm guidelines for coding & reporting, section i.c.13 1© kathleen...
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Musculoskeletal System
ICD-10-CM codes M00-M99
ICD-10-CM Guidelines for Coding & Reporting, Section I.C.13
1© Kathleen Peterson, MS, RHIA, CCS
R25 Abnormal involuntary movements◦ Cramp and spasm
R26 Abnormalities of gait and mobility R27 Other lack of coordination R29.6 Repeated falls
◦ Z91.81 History of falling, At risk for falling R29.890 Loss of height R29.891 Ocular torticollis
© Kathleen Peterson, MS, RHIA, CCS 2
Symptoms & signs involving musculoskeletal system
Official Coding Guidelines, I.C.13.a-d Conditions coded to this chapter include
◦ M1a Chronic Gout ◦ M 10 Gout ◦ M30 Polyarteritis nodosa◦ M26 Dentofacial anomalies, including
malocclusion◦ M27 Diseases of jaw◦ M84.3- Stress fractures◦ M84.4- through M84.6- Pathological fractures◦ Bone, joint or muscle conditions that are recurrent
or resulting from a healed injury
Musculoskeletal System & Connective Tissue: Features in ICD-10-CM
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I.C.13.a. Site and laterality◦ Site represents bone, joint or muscle involved◦ Some conditions may have a code for “multiple
sites” M10.09 Idiopathic gout, multiple sites
◦ If category does not have “multiple sites” code, then assign codes to indicate different sites M24.4- Recurrent dislocation of joint
◦ Bone vs. joint: Although bone affected may be at the joint, the site designation will be the bone. M87.03- Idiopathic aseptic necrosis of radius, ulna,
and carpus
© Kathleen Peterson, MS, RHIA, CCS 4
ICD-10-CM Official Guidelines
I.C.13.b. Acute traumatic vs. chronic or recurrent musculoskeletal condition◦ Any current, acute injury is coded to Chapter 19,
Injury S83.014A Lateral dislocation of right patella, initial
episode
◦ Bone, joint or muscle conditions that result from healed injury or are recurrent are usually found in Chapter 13, Musculoskeletal system M22.11 Recurrent incomplete dislocation of right knee
◦ If documentation is unclear whether acute vs. chronic or recurrent condition, query the provider.
© Kathleen Peterson, MS, RHIA, CCS 5
ICD-10-CM Official Guidelines
Joint Derangement◦ Recurrent – see Derangement, joint, recurrent◦ Due to current injury – see Derangement, joint, current
injury and Derangement, joint
Joint replacement◦ Assign code for disease process resulting in joint
replacement◦ Assign Z96.6- for orthopedic joint replacement on
subsequent admissions
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Derangement / Joint replacement
© Kathleen Peterson, MS, RHIA, CCS
ICD-10-CM coding guideline I.C.13.c Bone structure is weakened due to disease
process◦ Osteoporosis, osteomalacia, osteomyelitis, or
neoplasm Review physician documentation
◦ Trauma fracture are coded to Injuries◦ Pathological fracture M80, M84.4-, M84.5-, M84.6-
7th characters are required to show initial, subsequent or sequela
◦ Stress fracture repetitive force see M84.3- Use additional external cause code(s) to identify cause
of stress fracture Example: Y93.01, Activity walking, marching and hiking
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Pathological fractures
© Kathleen Peterson, MS, RHIA, CCS
Identify sites: pelvis, extremities, vertebrae◦ Stress fractures of vertebrae are termed “fatigue
fractures”.
Identify episode of care with 7th character◦ Initial, subsequent, sequela
M84.311A Stress fracture, right shoulder, initial episode
M48.42xB Fatigue fracture of vertebra, cervical region, subsequent encounter for routine healing
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Stress Fracture
A Initial encounter for fractureActive treatment: surgical treatment, ED encounter, evaluation & treatment by new MD
D Subsequent encounter for fracture with routine healingCode use for fracture aftercare - change or remove cast, remove external or internal fixation device, medication adjustment, follow-up visits following fracture treatment)
G Subsequent encounter for fracture with delayed healing
K Subsequent encounter for fracture with nonunion
P Subsequent encounter for fracture with malunion
S Sequela
Pathological or Stress Fractures (M84.3 – M84.6): Seventh Characters
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M66 Spontaneous rupture of synovium and tendon◦ NOTE A spontaneous rupture is one that occurs
when a normal force is applied to tissues that are inferred to have less than normal strength.
M80 Osteoporosis with current pathological fracture◦ NOTE Fragility fracture is defined as a fracture
sustained with trauma no more than a fall from a standing height or less that occurs under circumstances that would not cause a fracture in a normal healthy bone.
Definitions in ICD-10-CM
© Kathleen Peterson, MS, RHIA, CCS 10
ICD-10-CM coding guideline I.C.13.d.
M81.- Osteoporosis without current pathological fracture◦ Assign code even if patient has had fracture in past
Z87.310, Personal hx of (healed) osteoporosis fracture, is also assigned with M81.-
M80.- Osteoporosis with current pathological fracture◦ Assign code for patients with current pathological fracture
at time of encounter Assign code to identify fracture site Use for patients with osteoporosis who suffer a fracture, even if
it was a minor fall or trauma, that would not usually break a normal, healthy bone.
© Kathleen Peterson, MS, RHIA, CCS 11
Osteoporosis
Includes kyphoscoliosis
Types◦ Idiopathic
Infantile (birth through age 4) Juvenile (ages 5 through 10) Adolescent (ages 11 through 17)
◦ Secondary Neuromuscular or other
◦ Thoracogenic◦ Other form◦ Unspecified
Identify site: cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral, sacral/sacrococcygeal, unspecified
© Kathleen Peterson, MS, RHIA, CCS 12
Scoliosis (M41.-)
Assign ICD-10-CM codes for:
1. Cervical spondylosis, C5-6, C6-7
2. Deformity of left ring finger, due to old flexor tendon laceration
3. Right hallux valgus
Let’s Practice!
© Kathleen Peterson, MS, RHIA, CCS 13