In this topic let us learn what is arthritis?, Criteria’s to refer medical record while coding arthritis ICD 10 codes and Arthritis ICD 10 codes along with examples.
What is Arthritis?
Arthritis is the inflammation of one or many joints which causes common symptoms like stiffness and pain and these get worse when getting older. Treatment can help reducing symptoms, but arthritis cannot be cured totally. Most type of Arthritis can lasts for many years or can be there life long.
There are several different types of arthritis depending on the causal organism (Gonococcal, Pneumococcal, Streptococcal etc.), Infectious, Juvenile, due to some other disease and many other. Common types of arthritis found in medical records are osteoarthritis and rheumatoid arthritis.
Criteria’s to Refer Medical Record while coding Arthritis ICD 10 Codes:
Before getting into the Arthritis ICD 10 codes, we need to know which areas of medical record to refer and confirm the type of arthritis for our patient.
HPI – Most of the patients comes to hospital for leg pain, hand pain, back pain and joint pains (eg: shoulder pain).
ROS – Particular anatomical site symptoms will be described in this section.
Physical Exam – Physician personally checks the area and confirms the joint pain, stiffness, swelling or warmth and also checks if joint can be moved or not.
Physician orders lab tests(Blood, Urine or Joint fluid test like Arthrocentesis), radiology tests (X-ray, CT, MRI or Ultrasound) depending on which type of arthritis he suspects.
As per coding policies, coders should not diagnose a disease, coder can only code what Physician diagnosed. Hence check the assessment/final impression in the medical record to know the type of arthritis. The same should be confirmed by referring the test results(lab or radiology).
When referring the plan section we can see the types of further treatment plan by the Physician. It may be medicines, surgeries (Joint repair or Joint replacement) or even physical therapy.
Arthitis ICD 10 Codes
Always go by index and find the code.
- Osteoarthritis (OA): Category M15, M16, M17, M18, M19 and Dx M89.49
- Note : “Arthritis_degenerative” also leads to OA
Polyosteoarthritis or Osteoarthritis_ generalized leads to M15.9
M15.0 to M15.9 – It’s subcategories are primary, heberden’s nodes, bouchard’s nodes, secondary, erosive, other and unspecified.
- Osteoarthritis of Hip
M16.0 to M16.9 – select appropriate code as per bilateral, unilateral, primary, secondary etc.
- Osteoarthritis of Knee
M17.0 to M17.9 – select appropriate code as per bilateral, unilateral, primary, secondary etc.
- Osteoarthritis of first carpometacarpal joint
M18.0 to M18.9 – select appropriate code as per bilateral, unilateral, primary, secondary etc.
- Primary Osteoarthritis – Wear and tear of the joint due to age.
M19.0111 to M19.09 – subcategories are as per anatomical sites.
- Post traumatic Osteoarthritis – After effect of an injury to that particular joint.
M19.111 to M19.19 – subcategories are as per anatomical sites.
- Secondary Osteoarthritis – Secondary to any other disease like obesity, inflammation.
M19.211 to M19.29 – subcategories are as per anatomical sites.
- Unspecified site – When not mentioned the anatomical site.
M19.90 to M19.93 – Subcategories have unspecified, primary, post traumatic and secondary codes.
- Exception :: Osteoarthritis_Spine = this guide us to see Spondylosis.
Eg: Osteoarthritis lumbar, cervical, lumbosacral, thoracic
- Rheumatoid Arthritis (RA)– Category M05, M06, M08
This category consists of RA with rheumatoid factor.
M05.00 to M05.09 – Felty’s syndrome
M05.9 – RA with rheumatoid factor unspecified.
M05.10 – M05.8A – Combination codes of with other diseases
- Below conditions should be compulsorily we need to combo code with RA even if the Physician does not link it, provided there is no conflict.
- Rheumatoid factor
- Splenomegaly and leukopenia
Heart, Visceral and lung involvement should be linked by physician.
M06.00 to M06.0A – RA without rheumatoid factor
M06.1 – Adult onset Still’s disease
M06.20 to M06.29 – Rheumatoid bursitis
M06.30 to M06.39 – Rheumatoid nodule
M06.4 – Inflammatory polyarthropathy
M06.80 to M06.8A – Other specified RA
M06.9 – RA unspecified
- Juvenile Arthritis – Arthritis occurs in children
M08.00 to M08.0A – unspecified Juvenile RA
M08.1 – Juvenile Ankylosing spondylitis
M08.20 to M08.2A – Juvenile RA With systemic onset
M08.3 – Juvenile rheumatoid polyarthritis (seronegative)
M08.40 to M08.4A – Pauciarticular juvenile RA
M08.80 to M08.89 – Other juvenile Arthritis
M08.90 to M08.9A – Unspecified juvenile Arthritis
- Arthritis Rheumatic – This guide us to see Arthritis_ rheumatoid.
- Arthritis Rheumatic_acute or subacute = this guide us to “fever, rheumatic”
- Pyogenic Arthritis – Caused by Bacteria
Codes from M00.00 to M00.09 – Caused by Staphylococcus
M00.10 to M00.19 – Caused by Pneumococci
M00.20 to M00.29 – Caused by other Streptococcus
M00.80 to M00.89 – Caused by other bacteria
M00.9 – Caused by unspecified bacteria
- Arthritis Gouty – This leads us to Gout
Category M1A and M10
- Polyarthritis – Arthritis of 5 or more joints is coded as polyarthritis instead of coding each joint arthritis.
ICD – M13.0
- Monoarthritis – Involvement of only one joint. Type of arthritis will not be mentioned in this case.
M13.10 to M13.179
Need to choose code as per anatomical site.
- Below are few other types of arthritis which indexes for Arthritis in ICD book.
Arthritis ICD 10 Example 1:
Patient comes in for left knee pain and swelling. Exam suspects arthritis. Physician orders arthrocentesis.
Procedure note for arthrocentesis confirms streptococcus.
Assessment – Pyogenic Arthritis
Code selection – Arthritis_Pyogenic_Streptococcus_left knee – M00.262
Arthritis ICD 10 Example 2:
HPI – Follow up of 45 year old female for X-ray and she has severe right shoulder pain. History of same shoulder fracture repaired 1 year ago which had happened while playing football.
Today Physician orders MRI which reveals osteoarthritis.
Assessment- Osteoarthritis due to prior trauma
Code selection – Osteoarthritis_post traumatic – M19.111
Arthritis ICD 10 Example 3:
A 12 year old patient comes with left ankle pain. Physician did exam and orders few lab tests.
Assessment – RA
Code selection –Need to select Juvenile Arthritis as patient is child. M08.072
Arthritis ICD 10 Example 4:
Patient comes to hospital with multiple joint pains to elbow, knee, shoulder, hip, foot. Physician diagnosed as Arthritis to multiple sites.
Code selection – “Arthritis_multiple sites” does not lead to a code in index. This should be coded as polyarthritis – M13.0, not M19.90
Arthritis ICD 10 Example 5:
75 year old male comes to hospital with left hip pain and swelling. PMH has diabetes. Physician orders for few tests.
Final impression – Arthritis due to diabetes.
Code selection – E11.618, here arthritis can be coded as combo with DM as physician linked both. If not linked, cannot assume and code combo.