Health Information Management

Osteoporosis and osteomyelitis coding in ICD-10-CM

JustCoding News: Outpatient, March 21, 2012

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Osteoporosis and osteomyelitis both affect the bones, but in different ways. Osteoporosis is a thinning of the bone that often leads to pathologic fractures. It is also a systemic condition, meaning that all bones of the musculoskeletal system are affected.

Meanwhile, osteomyelitis is an infection in the bone caused by bacteria or fungus, says Robert S. Gold, MD, CEO and cofounder of DCBA, Inc., an Atlanta-based consulting company.

Coders will find specific guidelines and additional code choices for these two conditions when reporting them in ICD-10-CM as compared to ICD-9-CM.
 

Osteoporosis and fractures
Osteoporosis causes more pathologic fractures than cancer, Gold says. Unfortunately, most physicians don’t call a fracture pathologic unless it is caused by a malignancy, he says.

That can be a problem for coders, says Sandy Nicholson, MA, RHIA, vice president of Health Information Services for DCBA, Inc. “It’s up to the physician to document whether it is a pathologic fracture or an acute fracture caused by an injury.”

If coders don’t know whether the fracture is pathologic or traumatic, they won’t be able to select the correct series of codes to use, let alone the specific code. The increased specificity and documentation requirements in ICD-10-CM offers an opportunity to educate physicians about the importance of noting that fractures are pathologic, Gold says.

Physicians should document the following items for osteoporosis:

  • Identify whether it is with or without current pathological fracture and history of pathological fracture
  • Name the bone fractured and laterality, as appropriate
  • Identify whether osteoporosis is age-related vs. other specific cause (e.g., chronic steroid use, vitamin deficiency)

With a pathologic fracture, the fall or trauma is not significant enough to break a healthy bone. If a patient breaks both legs in a car accident, that is clearly not a pathologic fracture because of the level of trauma involved, Gold says. However, if the patient leans over to place a dish on the dinner table and breaks her back, that likely is a pathologic fracture, he says. Leaning over is generally not enough to break a healthy bone.

If a patient suffers a fall or trauma that results in a fracture, don’t assume the fracture is traumatic. If the fall or trauma is not enough to break a health bone, the fracture is pathologic, Nicholson says.

Coding for osteoporosis and fractures
Coders will find the ICD-10-CM codes for fractures caused by osteoporosis in the code category M80- (osteoporosis with current pathological fracture). Coders should only report a code from the M80- series when the patient has a current pathologic fracture at the time of the encounter. When coding for the fracture, select the code based on the site of the fracture, not the location of the osteoporosis, Nicholson says. A sample of the codes for a pathologic fracture with osteoporosis includes:

  • M80.011, age-related osteoporosis with current pathological fracture, right shoulder
  • M80.012, age-related osteoporosis with current pathological fracture, left shoulder
  • M80.021, age-related osteoporosis with current pathological fracture, right humerus
  • M80.022, age-related osteoporosis with current pathological fracture, left humerus
  • M80.871, other osteoporosis with current pathological fracture, right ankle and foot
  • M80.872, other osteoporosis with current pathological fracture, left ankle and foot

As with other fracture codes, those for pathologic fractures include laterality, although the codes do include a code for unspecified shoulder, humerous, ankle, foot, and so on.
Note that these codes also require a seventh character to indicate episode of care:

  • A, initial encounter for 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

Osteoporosis without fracture
If the patient does not have a current fracture, coders should select a code from the M81- series (osteoporosis without current pathological fracture), even if the patient had a pathologic fracture in the past, Nicolson says. The M81- series contains only three codes:

  • M81.0, age-related osteoporosis without current pathological fracture
  • M81.6, localized osteoporosis [Lequesne]
  • M81.8, other osteoporosis without current pathological fracture

Site is not a component of the codes under category M81 because osteoporosis is a systemic condition. However, coders should report status code Z87.310 (personal history of [healed] osteoporosis fracture) after the osteoporosis code if applicable, Nicholson says. The Z code is similar to the V codes currently found in ICD-9-CM.

Coding osteomyelitis
Osteomyelitis is divided into several types depending on where an infection begins and where it occurs. Types of osteomyelitis include:

  • Infections that travel through the bloodstream
  • Infections that occur after injury or surgery
  • Infections in people with poor circulation
  • Infection in the bones of the spine

A fracture or other trauma can predispose a bone to an osteomyletitis infection. In some cases, a patient suffers a cut directly over the bone, which leads to an infection, Gold says. An open fracture also offers plenty of opportunity for a bone to become infected. For example, road tar can get in to the body through an open break suffered in a car accident.

Osteomyelitis can also travel by hematogenous spread, which often confuses people, Gold says. In this type of osteomyelistis, the patient has an infection in the body somewhere distant from the bone and bacterial organisms get into the blood stream. The bacteria then attack a bone that has some type of change or weakness, such as arthritic changes or a diseased portion of the bone, and create an osteomyelitic infection, Gold says.

In ICD-10-CM, coders will find osteomyelitis codes in the M86- series. Characters four through six of the code identify etiology, anatomic site, severity, and other details, Gold says. For example, coders will find the following codes in the M86- series.

  • M86.061, acute hematogenous osteomyelitis, right tibia and fibula
  • M86.062, acute hematogenous osteomyelitis, left tibia and fibula
  • M86.131, other acute osteomyelitis, right radius and ulna
  • M86.132, other acute osteomyelitis, left radius and ulna
  • M86.241, subacute osteomyelitis, right hand
  • M86.242, subacute osteomyelitis, left hand
  • M86.371, chronic multifocal osteomyelitis, right ankle and foot
  • M86.372, chronic multifocal osteomyelitis, left ankle and foot

Coders also have to look for diabetic osteomyelitis, which can result from a non-healing ulcer. Patients with diabetic neuropathy or peripheral vascular disease often have osteomyelitis as well, Gold says. With diabetic neuropathy, the patient can’t feel the infection and don’t know it’s there.

For a patient with chronic diabetic osteomyelitis, coders would look to the M86.6 series for other chronic osteomyelitis. The fifth character 7 identifies the ankle and foot, while the sixth character will identify laterality—left, right, or unspecified. In this case, coders do not need to assign a seventh character because it is not a traumatic injury. Therefore, for chronic diabetic osteomyelitis of the left heel, coders would assign code M86.672.
 

E-mail your questions to Senior Managing Editor Michelle A. Leppert, CPC-A, at mleppert@hcpro.com.
 



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