Orthopedic Coding Alert

Focus on left, right for the new 2014 diagnoses.

Joint effusion (not to be confused with joint fusion) is the painful increase of intra-articular fluid. This occurs because of trauma, inflammation, hematologic conditions, or infection.

ICD-9-CM Codes: Currently, you should report this condition with:

• 719.00, Effusion of joint site unspecified
• 719.01, Effusion of joint of shoulder region
• 719.02, Effusion of upper arm joint
• 719.03, Effusion of forearm joint
• 719.04, Effusion of hand joint
• 719.05, Effusion of joint of pelvic region and thigh
• 719.06, Effusion of lower leg joint
• 719.07, Effusion of ankle and foot joint
• 719.08, Effusion of joint of other specified sites
• 719.09, Effusion of joint of multiple sites

ICD-10-CM Codes: As of October 1, 2014, you will report joint effusions with the following codes:

• M25.40, Effusion, unspecified joint
• M25.411, Effusion, right shoulder
• M25.412, Effusion, left shoulder
• M25.419, Effusion, unspecified shoulder
• M25.421, Effusion, right elbow
• M25.422, Effusion, left elbow
• M25.429, Effusion, unspecified elbow
• M25.431, Effusion, right wrist
• M25.432, Effusion, left wrist
• M25.439, Effusion, unspecified wrist
• M25.441, Effusion, right hand
• M25.442, Effusion, left hand
• M25.449, Effusion, unspecified hand
• M25.451, Effusion, right hip
• M25.452, Effusion, left hip
• M25.459, Effusion, unspecified hip
• M25.461, Effusion, right knee
• M25.462, Effusion, left knee
• M25.469, Effusion, unspecified knee
• M25.471, Effusion, right ankle
• M25.472, Effusion, left ankle
• M25.473, Effusion, unspecified ankle
• M25.474, Effusion, right foot
• M25.475, Effusion, left foot
• M25.476, Effusion, unspecified foot
• M25.48, Effusion, other site

ICD-10-CM Change: Rather than choosing your effusion of joint code based on anatomical region (i.e., knee, ankle and foot joint, etc.) as in ICD-9-CM, you will choose your code based on increased anatomical regions (knee, elbow, ankle, foot, etc.) as well as laterality (right, left, unspecified). If the patient has bilateral joint effusion, you can report both a right and left code.

You also have an unspecified code, but you should always code to the highest level of specificity.

Documentation: The physician probably already documents the side of the patient’s body in which the joint effusion is occurring, and with ICD-10-CM, you will be able to reflect that.

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

Effusion

- joint M25.40
   -- ankle M25.47-
   -- elbow M25.42-
   -- foot joint M25.47-
   -- hand joint M25.44-
   -- hip M25.45-
   -- knee M25.46-
   -- shoulder M25.41-
   -- specified joint NEC M25.48
   -- wrist M25.43-

Coder tips: Underneath the M25.4 category (Effusion of joint), you will see an Excludes1 note that prevents you from reporting any of these codes with hydrarthrosis in yaws (A66.6), intermittent hydrarthrosis (M12.4-), and other infective (teno)synovitis (M65.1-).