Musculoskeletal System ICD-10-CM codes M00-M99 ICD-10-CM Guidelines for Coding & Reporting, Section I.C.13 © Kathleen Peterson, MS, RHIA, CCS 1

Symptoms & signs involving musculoskeletal system 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

Musculoskeletal System & Connective Tissue: Features in ICD-10-CM 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 © Kathleen Peterson, MS, RHIA, CCS

ICD-10-CM Official Guidelines 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

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

Derangement / Joint replacement 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 © Kathleen Peterson, MS, RHIA, CCS

Pathological fractures 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 © Kathleen Peterson, MS, RHIA, CCS 7

Stress Fracture 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 © Kathleen Peterson, MS, RHIA, CCS

Pathological or Stress Fractures (M84.3 – M84.6): Seventh Characters Initial encounter for fracture Active treatment: surgical treatment, ED encounter, evaluation & treatment by new MD D Subsequent encounter for fracture with routine healing Code 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 © Kathleen Peterson, MS, RHIA, CCS

Definitions in ICD-10-CM 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. © Kathleen Peterson, MS, RHIA, CCS

Osteoporosis 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

Scoliosis (M41.-) 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

Let’s Practice! Assign ICD-10-CM codes for: Cervical spondylosis, C5-6, C6-7 Deformity of left ring finger, due to old flexor tendon laceration Right hallux valgus © Kathleen Peterson, MS, RHIA, CCS