Orthopedic Coding Alert

Check out how your joint pain diagnoses will be more detailed in 2015.

You may be used to applying a 719.4x code to many of your orthopedic practice’s claims, but you’ll have to up your specificity after October 1, 2015. Not only will you specify the anatomical location of the joint pain, but you’ll also be adding the laterality. 

Note: When pain occurs in a patient’s joint, this suggests the patient may be suffering from an orthopedic related condition. You should report a patient’s symptom in the absence of a definitive diagnosis.

Check Out Your Now and Future Diagnoses

ICD-9-CM: Currently, you apply one of these “pain in joint” codes:

• 719.40, Pain in joint site unspecified
• 719.41, Pain in joint involving shoulder region
• 719.42, Pain in joint involving upper arm
• 719.43, Pain in joint involving forearm
• 719.44, Pain in joint involving hand
• 719.45, Pain in joint involving pelvic region and thigh
• 719.46, Pain in joint involving lower leg
• 719.47, Pain in joint involving ankle and foot
• 719.48, Pain in joint involving other specified sites
• 719.49, Pain in joint involving multiple sites

ICD-10-CM: Check out how your anatomical options will expand in 2015:

• M25.50, Pain in unspecified joint
• M25.511, Pain in right shoulder
• M25.512, Pain in left shoulder
• M25.519, Pain in unspecified shoulder
• M25.521, Pain in right elbow
• M25.522, Pain in left elbow
• M25.529, Pain in unspecified elbow
• M25.531, Pain in right wrist
• M25.532, Pain in left wrist
• M25.539, Pain in unspecified wrist
• M25.551, Pain in right hip
• M25.552, Pain in left hip
• M25.559, Pain in unspecified hip
• M25.561, Pain in right knee
• M25.562, Pain in left knee
• M25.569, Pain in unspecified knee
• M25.571, Pain in right ankle and joints of right foot
• M25.572, Pain in left ankle and joints of left foot
• M25.579, Pain in unspecified ankle and joints of unspecified foot

Note: Notice how the sixth digit signifies the anatomic location. For instance, right = 1, left = 2, and unspecified = 9. Therefore, you have no reason to ever use “unspecified.” 

Here’s How Your Options Change

Your joint pain codes in ICD-9-CM (719.4x) are similar to your joint pain codes in ICD-10-CM (M25.5-). The differences are that ICD-10-CM increases anatomical specificity by adding right and left options where applicable and also takes away “joint pain” from the descriptor. The codes specify “pain” only.

You do have codes of unspecified sides or unspecified joint, but you should always code to the highest specificity. 

Documentation: Your physician probably already documents the anatomical region where the patient complains of joint pain. After ICD-10 goes into effect, you will have a way to reflect this on your claim. 

Here is how you will locate these codes specific to joint pain in your Alphabetic Index:

Pain(s) (see also Painful) R52

- joint M25.50
- - ankle M25.57-
- - elbow M25.52-
- - foot M25.57-
- - hip M25.55-
- - knee M25.56-
- - shoulder M25.51-
- - toe M25.57-
- - wrist M25.53-
- shoulder M25.51-

Don’t Miss These Coding Tips

You will find two Excludes2 notes.

Under M25.5 (Pain in joint), you will find an Excludes2 note that tells you that reporting any of these codes with pain in hand (M79.64-), pain in fingers (M79.64-), pain in foot (M79.67-), pain in limb (M79.6-), and pain in toes (M79.67-) codes isn’t likely but still possible. Your physician’s documentation needs to support this.