Wiki Basilar thumb arthritis


New Orleans, LA
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I need some clarification on which dx I can use for basilar thumb arthritis. The Dr. goes back and forth between M19.031 and M19.041 (depending on LT or RT). I use M19.041/2. However when the Dr. does xrays of the hand and wrist and the dx is basilar thumb arthritis, I am at a stand still on what to code for the wrist x ray?
From an Orthopedic standpoint, "arthritis of the base of the thumb" most likely & commonly refers to arthritis of the First Carpometacarpal Joint of the thumb, M18.1 _, if it is Primary (Degenerative) Osteoarthritis, and unilateral. Arthritis of the First Metacarpophalangeal Joint (M19.04 _) is rare by comparison, though it can occur. Confusingly, it would also be "arthritis at the base of the thumb." But I would go with M18. _ _. Also, your physician needs to be more specific in his documentation (good luck with that too).

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
Am I reading correctly that the doctor has his own XRAY machine and performs the Xray and interpretation as well?

Office X-ray

I am a little confused about some of the previous comments. Unless Hospital Based or Employed, nearly all "independent" Orthopedics Surgeons, Groups, Clinics have their own
X-ray capabilities/departments in which they have their X-ray studies done, particularly plain X-rays, and many may have their own CT and MRI Scanners as well. So, having X-rays done "In House" is pretty much the "norm." As such, the "Office" can charge and bill the Technical Component of the X-ray study, which basically includes the X-ray Machine and Computer Equipment used (since these are now pretty much all digitized), and the Technician's time and work. The next issue for charges is the Professional Component, i.e. who reads the study and renders an interpretation/report. That is separate from the Technical Component. If the studies are read by a Radiologist, either part of or independent of the Orthopedic office/group/etc., then he/she has to dictate a separate report/document, which is then placed in the medical record. In some Orthopedic Groups or Clinics, the Orthopedic Surgeons may and can read their own studies, but in order to bill/charge for their interpretation/report, they have to dictate/create a separate document/report for the medical record separate from their Office Note, which usually includes X-ray study information (which may say exactly the same thing). However, the inclusion of an X-ray study interpretation in the Office Note does not constitute an/the "Official" X-ray study interpretation, which must be done as a separate report. Where I last practiced, we in the Orthopedic Department read our own plane studies, and had to dictate a separate "official" X-ray Report. The Clinic billed and collected for the Technical Component, billed for our Office Visit E&M, and also for our X-ray study interpretation reports, i.e. the Professional Component. We "farmed out" the reading of CTs and MRIs to other Radiology Specialists. We did have our own Radiologists that read "Orthopedic" X-ray Studies for other/non-orthopedic physicians in our Clinic that might order studies, for which they (the Radiologists) were then credited with the Professional Component. We in Orthopedics were not allowed to "reread" and charge for those studies, even if we might have disagreed some with their reading. Also, we were not allowed to "Cut and Paste" our clinical note information into a "Radiology Report" and charge for it twice so to speak. Again, I hope this is clear enough.

Respectfully submitted, Alan Pechacek, M.D.