Arthralgia vs Arthritis
"Arthralgia" literally mean "aches and pains." It is usually applied to joints, but is not restricted to joints, and can be more generalized such as arms and legs. As it applies to joints (only), it means "painful joint," but is really more of a symptom than a diagnosis, and is too nonspecific for use over a long time, when the emphasis of CD-10 is on "specificity" of diagnosis. As a general rule, using "symptoms" as a "diagnosis" can or should be done only on a temporary basis, until a more/the most "specific" diagnosis is identified. R52 is the Code for Unspecified Pain, and includes Acute Pain NOS, Generalized Pain NOS, Pain NOS, but Excludes Acute and Chronic Pain NEC (G89. _), Localized Unspecified Pain, and has a Coding Note of "Code to Pain by site such as Back (M54.9), Joint (M25.5), Limb (M79.6 _), etc." Specific "Joint Pain," i.e. "Joint Arthralgia," is covered in the M25.5 _ _ Code Set, but again is not very specific, and there is no code for "multiple joints" which is what "Polyarthralgia" means. What it amounts to is that there is no code for "Polyarthralgia." I don't know what the PT thinks he/she is using, but he/she needs to be notified that Polyarthralgia is not a legitimate diagnosis. Using/listing multiple M25.5 _ _ Joint Pain codes may work for a while, but my "Gut" feeling is that over time, the CMS, insurers, etc. will say that these are not "specific enough," and will want more specific codes for what is making the joint hurt, i.e. arthritis, etc., in order to approve studies, testing, therapy, procedures.
As for your physician, he needs to be specific as well, and provide more supportive documentation for his diagnoses of "Arthritis." He needs to designate which joints, extremity &/or spinal, are arthritic and he is treating (with medications or PT). There is a code for Primary Generalized Osteoarthritis (M15.0) (part of M15. _ Code Set for Polyosteoarthritis, which requires Osteoarthritis of 5 or more extremity joints), but does not apparently include spinal arthritis (Spondylosis). If the patient does not have the requisite number of joints to fulfill this code, then each of the joints would have to be coded separately using codes from M16 (Hip), M17 (Knee), M18 (CMC Joint of Thumb), and/or M19 (Other Joints). So if the patient has multiple joint arthritis (<5, use/list codes from M16-19; 5+, use M15.0), and neck, upper, and/or lower back pain from spinal arthritis (Spondylosis), then you could code and the appropriate Spondylosis codes (M47.8 _ _, Other Spondylosis, without myelopathy or radiculopathy).
I hope this helps. It is a confusing area, and there may be some other opinions from others.
Respectfully submitted, Alan Pechacek, M.D.
