Wiki Bilateral primary osteoarthritis of knee

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pellison

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X-ray - there were two views done on the left knee and the dx was M17.0 , a biller was questioning why it is not changeable to "unilateral"? M17.12?

The doctor's dx was Bilateral primary osteoarthritis of knee.

I would have billed 73560,LT; M17.0? Instead of Unilateral. Please advise.

Thank you
pae
 
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Was the xray only done on the LT knee? If so, I would think the DX should point to just the LT knee.

If there is an E/M billed the same day & the physician went over the osteoarthritis in both knees but decided to just xray the LT knee - then the E/M DX should point to the bilateral code.

I could be wrong, but just my input...
 
hopepg said:
Was the xray only done on the LT knee? If so, I would think the DX should point to just the LT knee.

If there is an E/M billed the same day & the physician went over the osteoarthritis in both knees but decided to just xray the LT knee - then the E/M DX should point to the bilateral code.

I could be wrong, but just my input...
Click to expand...

Sorry, I have updated my question, please see below and thank you for answering:

Bilateral primary osteoarthritis of knee

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X-ray - there were two views done on the left knee and the dx was M17.0 , a biller was questioning why it is not changeable to "unilateral"? M17.12?

The doctor's dx was Bilateral primary osteoarthritis of knee.

I would have billed 73560,LT; M17.0? Instead of Unilateral. Please advise.

Thank you
pae
 
If they have a bilateral condition and they are only being treated on one side, I think it should still be the bilateral diagnosis. They do have the dx on both sides and the fact it's on the right side does affect treatment of the left side even if the RT side is not being worked on at the time.
 
I go with what the provider is currently treating. It does not make sense to me to code a bilateral diagnosis with a a unilateral procedure or service. You code the diagnosis that is currently managed controlled or treated. So even if bilateral disease is documented, the provider spent this encounter content aerating on only the one side. One of the problems I know several have run into with ICD-9 was the lack of the ability to indicate one side or the other. And if the provider performed a procedure on only one side this week and the opposite side the next week, then too many times the second service denied as an inclusive service despite the use of the modifier. So if you use the bilateral DX even though only one side was the focus and then next week the other side is the focus and you use the bilateral dx again, then you are faced with the exact same problem.
My opinion is to make the modifiers and the diagnosis codes for laterality match.
 
CodingKing said:
If they have a bilateral condition and they are only being treated on one side, I think it should still be the bilateral diagnosis. They do have the dx on both sides and the fact it's on the right side does affect treatment of the left side even if the RT side is not being worked on at the time.
Click to expand...

I agree...

My personal opinion is report what is documented. My feeling are if the physician documents it, it is relevant, and needs to be reported exactly as documented. Bilateral primary osteoarthritis is more difficult to manage than if only one side is affected and it is not an accurate statement to say the osteoarthritis is unilateral.
 
mitchellde said:
And if the provider performed a procedure on only one side this week and the opposite side the next week, then too many times the second service denied as an inclusive service despite the use of the modifier.
Click to expand...

I know everyone hates appeals and that insurance companies are wrong all the time but I don't think we should be less specific on a diagnosis because it makes it easier to get the claim paid. The insurance company need to fix their systems if thy are ignoring laterality modifiers.
 
I was not implying that you be less specific just to get the claim paid.. I was stating the opposite. That is be specific for the what was exactly treated at the encounter and the claim will naturally be paid. If the bilateral condition was not treated then code what was treated. Just because a patient has a given condition does not mean we code it. You what is managed controlled or treated. That was my point.
 
Bilateral vs unilateral

I agree with Debra on this one! I think of this the same way as cancer coding, where this subject comes up frequently. the doctor knows the patient has bilateral OA,but he is currently only checking on the one side; maybe for further treatment or because the patient has more pain on that side. Like cancer coding, the cancer site receiving care is the primary reason for the visit, so it should be coded first even if it isn't the primary cancer. it is the focus/reason/medical necessity for that visit. All other diagnoses are secondary.

Granted, I work in radiology where these things are a little more tidy in the documentation, and there are some differences in choosing the first listed diagnosis. I hope this helps!

Amy Meyers, CPC, ICD-10 certified
 
Interesting opinions and all may be valid depending on your internal coding policies. My suggestion is, I would ask and see if there are internal policies suggesting that you code by site when coding. I do not think ICD-10 general guidelines support coding osteoarthritis by site being treated or there would not be a need for unspecified codes.

I tend to always lean toward coding exactly what is documented and never assume anything. If the osteoarthritis is in both knees how do we actually know which side is being treated? The doctor could be treating the right but monitoring the left.

I also code radiology and we may have one x-ray flow through today and another 2 days from now. Both for the same date of service. If these were bilateral x-rays and we coded one to RT and one to LT when a bilateral code exist and a bilateral condition was documented, I would count this as invalid coding in my audit.
 
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