Musculoskeletal System

ICD-10-CM codes M00-M99

ICD-10-CM Guidelines for Coding & Reporting, Section I.C.13

1© Kathleen Peterson, MS, RHIA, CCS

R25 Abnormal involuntary movements◦ Cramp and spasm

R26 Abnormalities of gait and mobility R27 Other lack of coordination R29.6 Repeated falls

◦ Z91.81 History of falling, At risk for falling R29.890 Loss of height R29.891 Ocular torticollis

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Symptoms & signs involving musculoskeletal system

Official Coding Guidelines, I.C.13.a-d Conditions coded to this chapter include

◦ M1a Chronic Gout ◦ M 10 Gout ◦ M30 Polyarteritis nodosa◦ M26 Dentofacial anomalies, including

malocclusion◦ M27 Diseases of jaw◦ M84.3- Stress fractures◦ M84.4- through M84.6- Pathological fractures◦ Bone, joint or muscle conditions that are recurrent

or resulting from a healed injury

Musculoskeletal System & Connective Tissue: Features in ICD-10-CM

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I.C.13.a. Site and laterality◦ Site represents bone, joint or muscle involved◦ Some conditions may have a code for “multiple

sites” M10.09 Idiopathic gout, multiple sites

◦ If category does not have “multiple sites” code, then assign codes to indicate different sites M24.4- Recurrent dislocation of joint

◦ Bone vs. joint: Although bone affected may be at the joint, the site designation will be the bone. M87.03- Idiopathic aseptic necrosis of radius, ulna,

and carpus

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ICD-10-CM Official Guidelines

I.C.13.b. Acute traumatic vs. chronic or recurrent musculoskeletal condition◦ Any current, acute injury is coded to Chapter 19,

Injury S83.014A Lateral dislocation of right patella, initial

episode

◦ Bone, joint or muscle conditions that result from healed injury or are recurrent are usually found in Chapter 13, Musculoskeletal system M22.11 Recurrent incomplete dislocation of right knee

◦ If documentation is unclear whether acute vs. chronic or recurrent condition, query the provider.

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ICD-10-CM Official Guidelines

Joint Derangement◦ Recurrent – see Derangement, joint, recurrent◦ Due to current injury – see Derangement, joint, current

injury and Derangement, joint

Joint replacement◦ Assign code for disease process resulting in joint

replacement◦ Assign Z96.6- for orthopedic joint replacement on

subsequent admissions

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Derangement / Joint replacement

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ICD-10-CM coding guideline I.C.13.c Bone structure is weakened due to disease

process◦ Osteoporosis, osteomalacia, osteomyelitis, or

neoplasm Review physician documentation

◦ Trauma fracture are coded to Injuries◦ Pathological fracture M80, M84.4-, M84.5-, M84.6-

7th characters are required to show initial, subsequent or sequela

◦ Stress fracture repetitive force see M84.3- Use additional external cause code(s) to identify cause

of stress fracture Example: Y93.01, Activity walking, marching and hiking

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Pathological fractures

© Kathleen Peterson, MS, RHIA, CCS

Identify sites: pelvis, extremities, vertebrae◦ Stress fractures of vertebrae are termed “fatigue

fractures”.

Identify episode of care with 7th character◦ Initial, subsequent, sequela

M84.311A Stress fracture, right shoulder, initial episode

M48.42xB Fatigue fracture of vertebra, cervical region, subsequent encounter for routine healing

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Stress Fracture

A Initial encounter for fractureActive treatment: surgical treatment, ED encounter, evaluation & treatment by new MD

D Subsequent encounter for fracture with routine healingCode use for fracture aftercare - change or remove cast, remove external or internal fixation device, medication adjustment, follow-up visits following fracture treatment)

G Subsequent encounter for fracture with delayed healing

K Subsequent encounter for fracture with nonunion

P Subsequent encounter for fracture with malunion

S Sequela

Pathological or Stress Fractures (M84.3 – M84.6): Seventh Characters

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M66 Spontaneous rupture of synovium and tendon◦ NOTE A spontaneous rupture is one that occurs

when a normal force is applied to tissues that are inferred to have less than normal strength.

M80 Osteoporosis with current pathological fracture◦ NOTE Fragility fracture is defined as a fracture

sustained with trauma no more than a fall from a standing height or less that occurs under circumstances that would not cause a fracture in a normal healthy bone.

Definitions in ICD-10-CM

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ICD-10-CM coding guideline I.C.13.d.

M81.- Osteoporosis without current pathological fracture◦ Assign code even if patient has had fracture in past

Z87.310, Personal hx of (healed) osteoporosis fracture, is also assigned with M81.-

M80.- Osteoporosis with current pathological fracture◦ Assign code for patients with current pathological fracture

at time of encounter Assign code to identify fracture site Use for patients with osteoporosis who suffer a fracture, even if

it was a minor fall or trauma, that would not usually break a normal, healthy bone.

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Osteoporosis

Includes kyphoscoliosis

Types◦ Idiopathic

Infantile (birth through age 4) Juvenile (ages 5 through 10) Adolescent (ages 11 through 17)

◦ Secondary Neuromuscular or other

◦ Thoracogenic◦ Other form◦ Unspecified

Identify site: cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral, sacral/sacrococcygeal, unspecified

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Scoliosis (M41.-)

Assign ICD-10-CM codes for:

1. Cervical spondylosis, C5-6, C6-7

2. Deformity of left ring finger, due to old flexor tendon laceration

3. Right hallux valgus

Let’s Practice!

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