Wiki Degenerative Joint Disease

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mbcool

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At my group I have one coder who codes this as localized (715.3X) every time, regardless of it being specified and regardless of the medical record that say's the patient has multiple joints involved (Bilateral is included).

I use the unspecified code (715.9X) when it is not specified or if the patient has multiple joint's, but the only proof I have is an Ingenix coding lab for physician's offices which states, "The physician must document localized or generalized, or the coder should assign the unspecified code".

Does anyone know of another place where this is spelled out for the coder?

Any help would be appreciated.
Thanks
 
Year: 2003

Issue: Fourth

Title: Correction-degenerative joint disease of knee

Body: Degenerative Joint Disease of Knee

Coding Clinic,Second Quarter 2003,
There was a correction because they had published the wrong code but basically this states: When degenerative joint disease affects only one site but is not identified as primary or secondary, it is assigned to subcategory 715.3.

I took this to mean if the note does not indicate that it is affecting more than one joint it is ok to use localized, but you need to know if it is primary or secondary.

However, I could be wrong.....does anyone else know?

Thanks
Tina
 
Djd

If the medical record just says DJD it's suppose to default to 715.90. If the DJD affects only one site, and not identified as primary or secondary it should be coded to 715.3x for example DJD knee. If the medical record says DJD multiple, it should be coded to 715.89.

The only documentation besides the ICD-9 book is the following Coding Clinics, 4Q 2003 V20 #4 PG 118 and 2Q 1995 V12 #2 PG5.

I'm not sure why the coder is always using 715.3x if the medical record only states DJD. In order to use 715.3X the site would have to be stated. It goes against ICD-9 coding convections to use 715.3X for DJD unspecified/no site specfied/not specified as generalized/not specified as localized primary/secondary. It's kind of confusing.

Thanks, I hope this helps.
 
From coding clinic 2 qrt 1995

Question:

When a patient has degenerative joint disease of both knees, what is the correct code assignment? We assigned code 715.96, Osteoarthrosis, unspecified whether generalized or localized, knee. Should we utilize a code that identifies multiple sites, e.g., code 715.06, Osteoarthrosis, generalized, knee (involving multiple joints)?

Answer:

Assign code 715.36, Osteoarthrosis, localized, not specified whether primary or secondary, for bilateral degenerative joint disease, knee. In the Tabular List (Volume 1), under category 715, Osteoarthrosis and allied disorders, an instructional note can be found:

NOTE: Localized, in the subcategories below, includes bilateral involvement of the same site.

This note should be interpreted to mean that bilateral involvement is included in the fifth digit for that site. Furthermore, when the degenerative joint disease affects only one site but is not identified as primary or secondary it is coded to 715.3x, Osteoarthrosis, localized, not specified whether primary or secondary. If it involves more than one site but is not specified as generalized, assign code 715.8x, Osteoarthrosis involving, or with mention of more than one site but not specified as generalized.
 
715.3# is correct if not stated as primary or secondary. If the note states DJD knee this indicates the localization (knee) but it does not indicate primary or secondary.
 
715.96

Can someone tell me when would I use 715.96 then.

I believe that it is to be used when it is documented as osteoarthritis of knee, but not mentioned by the provider as localized (in which case 715.36, 715.16, or 715.26 could be the possible codes), or generalized (in which case 715.0x could be the possible code series) and if none specified i.e., if not mentioned by the provider as localized or generalized, the code of choice would be 715.96. I believe the whole purpose of ICD-9-CM having 715.9X (unspecified whether generalized or localized) is for the physician to determine that the condition is really confined to the specified site and unless that is confirmed by the provider we cannot use 715.3X, but would use 715.9x.

Need your suggestions.
 
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