Do you know how to code for osteoarthritis when the type of arthritis isn’t specified?
You’ll use only one code (M16.0, Bilateral primary osteoarthritis of hip) for a patient with a diagnosis of osteoarthritis in both hips. But you must list two codes for a patient with osteoarthritis in both shoulders.
Why? When you search under “osteoarthritis, shoulder,” the alphabetic index sends you to M19.01- (Primary osteoarthritis, shoulder), a code that by itself is incomplete. You’ll need to select a sixth character to specify laterality — that is, right or left side.
While the ICD-10 code set offers codes that capture bilateral osteoarthritis (OA) affecting the hips as well as the knees (M17.0) and the first carpometacarpal joints (M18.0), no such bilateral code exists among the options for OA of the shoulders.
Coding guidelines mention the existence of bilateral codes and that they’re not available for every condition that can affect both sides of the body. If that’s the type of scenario you’re facing, the guidelines instruct to use separate codes for right and left. [I.B.13]
So, you’ll list two codes, M19.011 (Primary osteoarthritis, right shoulder) and M19.012 (Primary osteoarthritis, left shoulder) for a patient with bilateral shoulder OA.
Two codes also are required when OA affects bilateral joints in the elbows (M19.02-), wrists (M19.03-), hands (M19.04-) or ankles and feet (M19.07-).
Tip: Code a patient’s osteoarthritis as primary if the type of arthritis, such as post-traumatic or secondary, isn’t further specified, according to Q4 2016 Coding Clinic guidance.