Ob-Gyn Coding Alert

Check out how 733.00, 733.01, 733.90 get an ICD-10 facelift. 

Osteoporosis is essentially a bone disease caused by dropping estrogen levels in postmenopausal women. Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist.

Osteopenia, on the other hand, means the patient’s bone mineral density is lower than normal. While osteopenia can be a risk factor or precursor for developing osteoporosis, all patients who have osteopenia do not develop osteoporosis. For osteopenia, the physician may recommend calcium supplements and weight bearing exercises.

ICD-9-CM Codes: Currently, you should report these conditions with the following codes:

• 733.00, Osteoporosis unspecified
• 733.01, Senile osteoporosis
• 733.90, Disorder of bone and cartilage unspecified.

ICD-10-CM Codes: However, these diagnoses change after October 1, 2015:

• M81.0, Age-related osteoporosis without current pathological fracture
• M85.8--, Other specified disorders of bone density and structure
• M89.9, Disorder of bone, unspecified
• M94.9, Disorder of cartilage, unspecified.

Translation: Once ICD-10 goes into effect, you’ll report M81.0(Age-related osteoporosis without current pathological fracture) for senile osteoporosis (733.01). 

For 733.90, your osteopenia choices will expand to M85.8--, which requires 6 digits. The 5th digit will denote the anatomic site (e.g., thigh, forearm, shoulder, etc) while the 6th digit will denote the side of the body (e.g., right side). 

Caution: The ICD-10-CM Alphabetic index directly references the term “osteopenia” and lists those codes that you should assign. If you use the General Equivalency Mappings (GEMs) tools instead to pick the ICD-10 code, it will lead you instead to two incorrect codes: M89.9 (Disorder of bone, unspecified), or M94.9 (Disorder of cartilage, unspecified).

Documentation: For M81.0, you might see the following terminology:

• Involutional osteoporosis without current pathological fracture
• Osteoporosis NOS
• Postmenopausal osteoporosis without current pathological fracture
• Senile osteoporosis without current pathological fracture

For M85.--, the provider needs to document the part of the body that is affected by the osteoporosis, and well as which side is showing these changes. 

Here is how you will locate these codes in the Alphabetic Index:

Osteopenia M85.8-

 - borderline M85.8-

Osteoporosis (female) (male) M81.0

- age-related M81.0

- postmenopausal M81.0

Disorder(of) —see also Disease

- bone M89.9
- - density and structure M85.9
- - - specified type NEC M85.8-
- - - - ankle M85.87-
- - - - foot M85.87-
- - - - forearm M85.83-
- - - - hand M85.84-
- - - - lower leg M85.86-
- - - - multiple sites M85.89
- - - - neck M85.88
- - - - rib M85.88
- - - - shoulder M85.81-
- - - - skull M85.88
- - - - thigh M85.85-
- - - - upper arm M85.82-
- - - - vertebra M85.88

Coder’s tips: Underneath the M81 category, you’ll see a note instructing you to “use additional code to identify: major osseous defect, if applicable (M89.7-); personal history of (healed) osteoporosis fracture, if applicable (Z87.310).” You also have an Excludes1 note forbidding you from reporting any M81 code for osteoporosis with a current pathological fracture (M80.-) or Sudeck’s atrophy (M89.0).