Revenue Cycle Insider

Question: An adolescent patient presented with a right hip injury and the provider documented a diagnosis of “slipped capital femoral epiphysis” and mentioned that the cause was an injury. I submitted a claim with M93.001 but it was denied. How should I have coded this?

California Subscriber

Answer: The code you submitted, M93.001 (Unspecified slipped upper femoral epiphysis (nontraumatic), right hip), is an unspecified code, and your provider included enough documentation in their diagnosis to choose a more specific ICD-10-CM code.

The code you submitted is also a nontraumatic code, but you say your provider noted that the condition was the result of an injury. In your ICD-10-CM code book, look to the section Injuries to the hip and thigh (S70-S79), where you can find S79.01- (Salter-Harris Type I physeal fracture of upper end of femur). Since you know the injury occurred on the right femur, and the capital femoral epiphysis is the top of the femur, you should look to S79.011- (Salter-Harris Type I physeal fracture of upper end of right femur).

Code S79.01- also lists “acute on chronic slipped capital femoral epiphysis (traumatic)” and “acute slipped capital femoral epiphysis (traumatic),” as well as “capital femoral epiphyseal fracture,” so you know that you’re in the right place according to the documentation from your provider. The ICD-10-CM code book says that this code requires a 7^th character, so you may need to look to the documentation for certainty on the timing of the visit or query the provider to know whether the encounter was initial, subsequent, or sequela.   

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC