Cracking the Code

Coding Osteoarthritis

Arthritis is defined as inflammation of one or more joints, causing pain and stiffness that can worsen with age. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, known as degenerative joint disease, is a condition that develops over a period of time. It is a chronic condition that is a result of the cartilage in the joints wearing down. Cartilage is soft and flexible and allows easy movement at the joints. If the cartilage wears down, movement at the joints becomes painful because there is bone moving against bone. The codes for osteoarthritis are determined by site and laterality. The type of arthritis such as primary, secondary, or post-traumatic is also included. It is important to note that ‘primary’ does not have a known cause and ‘secondary’ develops because of an injury or disease.

Q: Jane has osteoarthritis localized in the left hip joint due to senile osteoporosis. What ICD-10-CM codes are reported?
A: M16.7, M81.0 Rationale: In the ICD-10-CM Alphabetic Index, we will look at Osteoarthritis/secondary/hip, guiding us to code M16.7. Secondary localized osteoarthritis is reported when the osteoarthritis develops because of an injury or disease (for example osteoporosis). Osteoporosis is then coded as an additional code. In the Alphabetic Index, we look for Osteoporosis (female) (male)/senile – see Osteoporosis, age-related. Osteoporosis/age-related guides us to M81.0. As always, we then verify the code selection in the Tabular List.
Reference: AHA Coding Handbook, FY 2022 ICD-10-CM Coding Guidelines
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