ICD-10 Osteoarthritis Coding

Messages
4
Best answers
0
I have seen several responses that state you may not default to primary OA if it is not stated it must be coded to most appropriate unspecified code if type is not documented. Is there anything in the official guidelines or is this just undersood rule? I located an article out on the internet that stated default to primary if not documented. Thanks in advance for any help.
 
No you cannot as a coder assume the provider means primary. Degenerative is synonymous with primary but other wise it must be documented. There is a code OA of the knee unspecified M17.9 so if not stated that is your only available choice. However not every location gives you an unspecified option such as elbow.
 
I have seen several responses that state you may not default to primary OA if it is not stated it must be coded to most appropriate unspecified code if type is not documented. Is there anything in the official guidelines or is this just undersood rule? I located an article out on the internet that stated default to primary if not documented. Thanks in advance for any help.

Can you direct me to the article you found? I code radiology and my providers are not specifying if primary, secondary etc, but they are saying location; I will get dinged on my audits if I use the unspecified codes so i need something to back up my use of the unspecified or other codes if chosen!
 
Just because an article says you can default does not mean that you can. Nothing in the official guidelines or code conventions indicates that it appropriate to defaul not documented to primary.
 
We are having discussions amongst our staff as to coding primary vs unspecified also. We are concerned that for most joints there is not a choice of "unspecified" osteoarthritis. However, we don't feel that it is appropriate to assume primary if it is not documented as such. From what I have read on various orthopedic posts, all osteoarthritis can also be labeled degenerative, not just primary osteoarthritis. Could you confirm your source of information that would support us using primary if the physician or radiologist only documents it as degenerative. Thanks!
 
Debra Mitchell, we bill for radiologists and they are telling us they wouldn't necessarily have enough info to know primary or secondary. What option do we have on the joints that don't have unspecified? I am completely stumped on this and would appreciate any help. :confused:
 
I assume if there is not enough information to be able to diagnose specifically then you would need to code the symptoms. I don't know the definitive answer, only that you cannot assume something.
 
Shoulder arthritis

I'm trying to code shoulder arthritis and there is no unspecified in this category? Not sure what to code here. Can't assume its primary.... Any thoughts?
 
There is mention of this in the 2016 CSI navigator for radiology diagnosis coding. It states "If the record does not indicated whether the OA is primary or secondary, the ICD-10-CM index tells you to assign a primary OA code when the disease is located in the hip, shoulder, elbow, hand or ankle/foot. However, when the OA involves the knee or first carpometacarpal (CMC) joint, the index refers you to an unspecified code rather than to a primary OA code for that site. The AHA central office has stated that this discrepancy is being referred to the National Center for Health Statistic for index modifications (private communication to Coding Strategies, July 3, 2014."
 
Last edited:
There is mention of this in the 2016 CSI navigator for radiology diagnosis coding. It states "If the record does not indicated whether the OA is primary or secondary, the ICD-10-CM index tells you to assign a primary OA code when the disease is located in the hip, shoulder, elbow, hand or ankle/foot. However, when the OA involves the knee or first carpometacarpal (CMC) joint, the index refers you to an unspecified code rather than to a primary OA code for that site. The AHA central office has stated that this discrepancy is being referred to the National Center for Health Statistic for index modifications (private communication to Coding Strategies, July 3, 2014."

Awesome thank you so much!!
 
Top