ICD 10 RULES
|Chapter 1||Certain Infectious and Parasitic Diseases (A00-B99)|
|Chapter 2||Neoplasms (C00-D49)|
|Chapter 3||Diseases of the Blood and Blood Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)|
|Chapter 4||Endocrine, Nutritional and Metabolic Diseases (E00-E90)|
|Chapter 5||Mental and Behavioral Disorders (F01-F99)|
|Chapter 6||Diseases of the Nervous System (G00-G99)|
|Chapter 7||Diseases of the Eye and Adnexa (H00-H59)|
|Chapter 8||Disease of the Ear and Mastoid Process (H60-H95)|
|Chapter 9||Diseases of the Circulatory System (I00-I99)|
|Chapter 10||Diseases of the Respiratory System (J00-J99)|
|Chapter 11||Diseases of the Digestive System (K00-K94)|
|Chapter 12||Diseases of the Skin and Subcutaneous Tissue (L00-L99)|
|Chapter 13||Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)|
|Chapter 14||Diseases of the Genitourinary System (N00-N99)|
|Chapter 15||Pregnancy, Childbirth and the Puerperium (O00-O99)|
|Chapter 16||Certain Conditions Originating in the Perinatal Period (P00-P96)|
|Chapter 17||Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99)|
|Chapter 18||Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)|
|Chapter 19||Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)|
|Chapter 20||External Causes of Morbidity (V01-Y99)|
|Chapter 21||Factors Influencing Health Status and Contact with Health Services (Z00-Z99)|
General RULES of ICD-10-CM
“SYMBOLS and CONVENTIONS” To get started with any new system, one must first understand the rules. I am going to address the symbols and conventions next.
Never code from the Alphabetical Index because important instructional notes may be missed.
1) In the text a ● colored dot cautions you to make sure you use additional digit(s) to ensure greatest specificity.
2) ■ “Unspecified” The Square before a code indicates there are more specific codes without the symbol. It is still a valid first line code but if possible look for the code with highest specificity.
3) “OGCR” This symbol indicates there is “Official Guidelines for Coding and Reporting”. The passage is usually placed near the codes in a colored box.
4) “CC” Indicates complications and comorbidities. “MCC” indicates Major Complications and comorbidities. Published in the Federal register these two codes address Inpatient Prospective Payment System (IPPS).
5) Z codes that have a number 1 inside a circle before them means the code must be listed first.
6) The ½ symbol inside a circle before a Z code indicates this code may be the first or second listed code.
7) The number 2 inside a circle before Z codes means it is listed as a secondary code.
8) The “Excludes 1” is when two conditions can not occur together.
9) The “Excludes 2” means not included here. This is the case where it is acceptable to use both the code and the excluded code together.
10) The Code first/Use additional code means when there are multiple body system manifestations you code the underlying condition first and the manifestation second.
11) “In diseases classified elsewhere” these codes are never permitted to be used as first line codes. These codes must be listed after the underlying condition.
12) “Code also” means two codes may be required but the sequencing of the codes is discretionary.
13) “7th characters” means the applicable 7th character must always be used and “placeholder x” uses as a 5th character at certain 6 character codes to allow for future expansion.
14) “and” This word is interpreted as either “and” or “or”.
15) “Includes” in a colored box further defines or gives examples of the content. This notation appears immediately under a code title. It also gives examples of the content of the category. Inclusion terms are included under certain four- to six-digit codes.
16) Abbreviations: “NEC”=”Not Elsewhere Classifiable” this is another specified code, used when a specific code is not available. “NOS” = “Not otherwise specified”, this indicates an unspecified code. Also, Codes in the Tabular List with “Unspecified…” in the title are for use when the information in the medical record is insufficient to assign a more specific code.
17) The instruction “see” acts as a cross-reference and directs the user to look elsewhere. This instruction is often found when the term or condition may not be the appropriate term. This is a mandatory instruction and must be followed for proper code selection.
18) “See also” is a reference instructional note to refer to a specific category, subcategory, or sub classification before making a code selection if you cannot find the diagnosis listed under a term in Volume 2.
19) Laterality: An unspecified side code is also provided should the side not be identified in the medical record. The unspecified side is either a character 0 or 9 depending on whether it is a fifth or sixth character.
20) Dummy Placeholders – ” using character “x.” The “x” is used as a fifth- or sixth-character placeholder to allow for future expansion. Some codes in ICD-10-CM require either 6 or 7 characters in the code. If the code, for example, had 5 characters and a seventh character was required based on the instructional notes, dummy placeholders would be used in sixth character position to allow for the seventh character extension to be reported.
21) [ ] Brackets are used in the index and to identify manifestation codes.
22)( ) Parentheses are used in both the Index to Diseases and Tabular List to enclose supplemental words that do not affect the code number. The terms within the parentheses are referred to as nonessential modifiers.
23) : Colon is used after an incomplete term that needs one or more of the modifiers that follow to make it assignable to a given category
24) – The dash at the end of a code indicates additional digits are required to complete the diagnostic term
25) , Comma–words following a comma are essential modifiers. The term in the inclusion note must be present in the diagnostic statement to qualify the code
26) Each ICD-10-CM diagnosis codes are to be reported ONCE for an encounter. When bilateral conditions exist, the one listed code counts when no distinct codes for laterality or two different conditions are classified.
27) Documentation for BMI should only report as secondary diagnosis codes.
RULES BY CHAPTER:
(This is a general outline, by no means can this document provide every rule, it is upto you the researcher to validate all rules by using this and other resources!!)
Chapter 1 : Certain Infectious and Parasitic Diseases (A00-B99)
HIV Infections, code only confirmed cases.
HIV Patients admitted for an HIV related condition, Code first HIV=B20 and the HIV related condition 2nd.
An HIV Patients admitted for an HIV Unrelated condition, code that first and the HIV-B20 2nd and any other subsequent diagnoses.
Asymptomatic HIV = Z21 used when the patient is described as “know HIV”, “HIV positive” Again, any symptoms related to active HIV is coded B20 in these cases.
Patient with inconclusive serology for HIV is coded as R75.
Patients previously diagnosed with HIV never should be assigned R75 or Z21, but B20.
Patients being tested for signs and/or symptoms of HIV, code the signs and symptoms. If you are counseling the patient for doing the test or the test results come back negative the proper coding is Z71.7
Certain infections are classified in other chapters other than Chapter 1. It is necessary then to select the isolated organism using Chapter 1, for example, B95 Category includes Streptococcus, Staphylococcus, and Enterococcus. B96 Other bacterial agents or B97 Viral agents are the additional codes in some cases which should be listed.
Infections resistant to antibiotics. You should be identifying and coding Z16 following the identified infection code in that case.
Coding Sepsis and Severe Sepsis Rules:
Unspecified Sepsis, A41.9
Severe Sepsis, R65.2 should not be used unless severe organ dysfunction is documented in the medical record.
Septic Shock is coded R65.21 but this is a second listed code, always code the underlying systemic infection code first.
Negative or inconclusive blood tests do not preclude using the diagnosis if clinically evident
Term Urosepsis is nonspecific and no longer acceptable.
When coding, expect to use 2 codes. First code the underlying systemic infection followed from the subcategory R65.2. If the organism that caused the sepsis is not documented then A41.9 is used. Acute organ dysfunction codes are then assigned those additional code(s).
Coding Sepsis and Severe Sepsis with a localized infection-cellulitis. If admitted to the hospital, the underlying systemic infection is coded first and the localized infection-cellulitis is coded second. On the other hand, a patient is admitted for a localized infection and then develops sepsis after admission. In this example the localized infection is coded first followed by the subcategory R65.2 in severe sepsis second and then after this additional codes for any acute organ dysfunction.
Trauma (noninfectious process-burn or serious injury) cases can lead to Sepsis and severe sepsis. If this scenario occurs, then the noninfectious code is sequenced first, the code from the subsection R65.2 should be assigned, and then any associated organ dysfunction next. However, if the infection meets the definition of primary diagnosis it is listed first before the noninfectious diagnosis. There may be cases where both the noninfectious and the infection meet the definition of principal diagnosis then either may be assigned as primary.
Chapter 12 : Diseases of the skin and subcutaneous tissue (L00-L99)
Excludes2: certain conditions originating in the perinatal period (P04-P96) certain infectious and parasitic diseases (A00-B99) complications of pregnancy, childbirth and the puerperium (O00-O9A) congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99) endocrine, nutritional and metabolic diseases (E00-E88) lipomelanotic reticulosis (I89.8) neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94) systemic connective tissue disorders (M30-M36) viral warts (B07.-)
Infections of the skin and subcutaneous tissue (L00-L08)
Use additional code (B95-B97) to identify infectious agent. Excludes2: hordeolum (H00.0) infective dermatitis (L30.3) local infections of skin classified in Chapter 1 lupus panniculitis (L93.2) panniculitis NOS (M79.3) pyogenic granuloma (L98.0) viral warts (B07.-) zoster (B02.-)
Bullous disorders (L10-L14)
Excludes1: benign familial pemphigus [Hailey-Hailey] (Q82.8) staphylococcal scalded skin syndrome (L00) toxic epidermal necrolysis [Lyell] (L51.2)
Dermatitis and eczema (L20-L30)
In this block the terms dermatitis and eczema are used synonymously and interchangeably. Excludes2: chronic (childhood) granulomatous disease (D71) dermatitis gangrenosa (L08.0) dermatitis herpetiformis (L13.0) dry skin dermatitis (L85.3) factitial dermatitis (L98.1) perioral dermatitis (L71.0) radiation-related disorders of the skin and subcutaneous tissue (L55-L59) stasis dermatitis (I83.1-I83.2)
Papulosquamous disorders (L40-L45) (NO Group Rules)
Urticaria and erythema (L49-L54)
Excludes1: Lyme disease (A69.2-) rosacea (L71.-)
Radiation-related disorders of the skin and subcutaneous tissue (L55-L59) (No Group Rules)
Disorders of skin appendages (L60-L75)
Excludes1:congenital malformations of integument (Q84.-)
Intraoperative and postprocedural complications of skin and subcutaneous tissue (L76) (No Group Rules)
Other disorders of the skin and subcutaneous tissue (L80-L99) (No Group Rules)
Chapter13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
Note: Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the causeof the musculoskeletal condition
Excludes2: arthropathic psoriasis (L40.5-) certain conditions originating in the perinatal period (P04-P96) certain infectious and parasitic diseases (A00-B99) compartment syndrome (traumatic) (T79.A-) complications of pregnancy, childbirth and the puerperium (O00-O9A) congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99) endocrine, nutritional and metabolic diseases (E00-E88) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Infectious arthropathies (M00-M02)
Note: This block comprises arthropathies due to microbiological agents. Distinction is made between the following types ofetiological relationship: a) direct infection of joint, where organisms invade synovial tissue and microbial antigen is present in the joint; b) indirect infection, which may be of two types: a reactive arthropathy, where microbial infection of the body isestablished but neither organisms nor antigens can be identified in the joint, and a postinfective arthropathy, wheremicrobial antigen is present but recovery of an organism is inconstant and evidence of local multiplication is lacking.
M00 Pyogenic arthritis Use additional code (B95.61-B95.8) to identify bacterial agent
M01 Direct infections of joint in infectious and parasitic diseases classified elsewhere
Code first underlying disease, such as: leprosy [Hansen’s disease] (A30.-) mycoses (B35-B49) O’nyong-nyong fever (A92.1) paratyphoid fever (A01.1-A01.4) Excludes1: arthropathy in Lyme disease (A69.23) gonococcal arthritis (A54.42) meningococcal arthritis (A39.83) mumps arthritis (B26.85) postinfective arthropathy (M02.-) postmeningococcal arthritis (A39.84) reactive arthritis (M02.3) rubella arthritis (B06.82) sarcoidosis arthritis (D86.86) typhoid fever arthritis (A01.04) tuberculosis arthritis (A18.01-A18.02)
M02 Postinfective and reactive arthropathies
Code first underlying disease, such as: congenital syphilis [Clutton’s joints] (A50.5) enteritis due to Yersinia enterocolitica (A04.6) infective endocarditis (I33.0) viral hepatitis (B15-B19) Excludes1: Behçet’s disease (M35.2) direct infections of joint in infectious and parasitic diseases classified elsewhere (M01.-) postmeningococcal arthritis (A39.84) mumps arthritis (B26.85) rubella arthritis (B06.82) syphilis arthritis (late) (A52.77) rheumatic fever (I00) tabetic arthropathy [Charcôt’s] (A52.16)
Inflammatory polyarthropathies (M05-M14)
M05 Rheumatoid arthritis with rheumatoid factor Excludes1: rheumatic fever (I00) juvenile rheumatoid arthritis (M08.-) rheumatoid arthritis of spine (M45.-)
M07 Enteropathic arthropathies Code also associated enteropathy, such as: regional enteritis [Crohn’s disease] (K50.-) ulcerative colitis (K51.-) Excludes1: psoriatic arthropathies (L40.5-)
M08 Juvenile arthritis Code also any associated underlying condition, such as: regional enteritis [Crohn’s disease] (K50.-) ulcerative colitis (K51.-) Excludes1: arthropathy in Whipple’s disease (M14.8) Felty’s syndrome (M05.0) juvenile dermatomyositis (M33.0-) psoriatic juvenile arthropathy (L40.54)
M1A Chronic gout Use additional code to identify: Autonomic neuropathy in diseases classified elsewhere (G99.0) Calculus of urinary tract in diseases classified elsewhere (N22) Cardiomyopathy in diseases classified elsewhere (I43) Disorders of external ear in diseases classified elsewhere (H61.1-, H62.8-) Disorders of iris and ciliary body in diseases classified elsewhere (H22) Glomerular disorders in diseases classified elsewhere (N08) Excludes1: acute gout (M10.-) gout NOS (M10.-) The appropriate 7th character is to be added to each code from category M1A 0 – without tophus (tophi) 1 – with tophus (tophi)
M10 Gout Acute gout Gout attack Gout flare Gout NOS Podagra Use additional code to identify: Autonomic neuropathy in diseases classified elsewhere (G99.0) Calculus of urinary tract in diseases classified elsewhere (N22) Cardiomyopathy in diseases classified elsewhere (I43) Disorders of external ear in diseases classified elsewhere (H61.1-, H62.8-) Disorders of iris and ciliary body in diseases classified elsewhere (H22) Glomerular disorders in diseases classified elsewhere (N08) Excludes1: chronic gout (M1A.-)
M12 Other and unspecified arthropathy Excludes1: arthrosis (M15-M19) cricoarytenoid arthropathy (J38.7)
M13 Other arthritis Excludes1: arthrosis (M15-M19) osteoarthritis (M15-M19)
M14 Arthropathies in other diseases classified elsewhere Excludes1: arthropathy in: diabetes mellitus (E08-E13 with .61-) hematological disorders (M36.2-M36.3) hypersensitivity reactions (M36.4) neoplastic disease (M36.1) neurosyphillis (A52.16) sarcoidosis (D86.86) enteropathic arthropathies (M07.-) juvenile psoriatic arthropathy (L40.54) lipoid dermatoarthritis (E78.81)
Osteoarthritis (M15-M19) Excludes2: osteoarthritis of spine (M47.-)
M15 Polyosteoarthritis Includes: arthritis of multiple sites Excludes1: bilateral involvement of single joint (M16-M19)
M19 Other and unspecified osteoarthritis Excludes1: polyarthritis (M15.-) Excludes2: arthrosis of spine (M47.-) hallux rigidus (M20.2) osteoarthritis of spine (M47.-)
Other joint disorders (M20-M25) Excludes2: joints of the spine (M40-M54)
M20 Acquired deformities of fingers and toes Excludes1: acquired absence of fingers and toes (Z89.-) congenital absence of fingers and toes (Q71.3-, Q72.3-) congenital deformities and malformations of fingers and toes (Q66.-, Q68-Q70, Q74.-)
M21 Other acquired deformities of limbs Excludes1: acquired absence of limb (Z89.-) congenital absence of limbs (Q71-Q73) congenital deformities and malformations of limbs (Q65-Q66, Q68-Q74) Excludes2: acquired deformities of fingers or toes (M20.-) coxa plana (M91.2)
M24 Other specific joint derangements Excludes1: current injury – see injury of joint by body region Excludes2: ganglion (M67.4) snapping knee (M23.8-) temporomandibular joint disorders (M26.6-)
M25 Other joint disorder, not elsewhere classified Excludes2: abnormality of gait and mobility (R26.-) acquired deformities of limb (M20-M21) calcification of bursa (M71.4-) calcification of shoulder (joint) (M75.3) calcification of tendon (M65.2-) difficulty in walking (R26.2) temporomandibular joint disorder (M26.6-)
Systemic connective tissue disorders (M30-M36) Includes: autoimmune disease NOS collagen (vascular) disease NOS systemic autoimmune disease systemic collagen (vascular) disease autoimmune disease, single organ or single cell-type -code to relevant condition category
Deforming dorsopathies (M40-M43)
M40 Kyphosis and lordosis Excludes1:congenital kyphosis and lordosis (Q76.4) kyphoscoliosis (M41.-) postprocedural kyphosis and lordosis (M96.-)
M41 Scoliosis Includes: kyphoscoliosis Excludes1: congenital scoliosis NOS (Q67.5) congenital scoliosis due to bony malformation (Q76.3) postural congenital scoliosis (Q67.5) kyphoscoliotic heart disease (I27.1) postprocedural scoliosis (M96.-)
M49 Spondylopathies in diseases classified elsewhere Includes: curvature of spine in diseases classified elsewhere deformity of spine in diseases classified elsewhere kyphosis in diseases classified elsewhere scoliosis in diseases classified elsewhere spondylopathy in diseases classified elsewhere Code first underlying disease, such as: brucellosis (A23.-) Charcot-Marie-Tooth disease (G60.0) enterobacterial infections (A01-A04) osteitis fibrosa cystica (E21.0) Excludes1: curvature of spine in tuberculosis [Pott’s] (A18.01) enteropathic arthropathies (M07.-) gonococcal spondylitis (A54.41) neuropathic [tabes dorsalis] spondylitis (A52.11) neuropathic spondylopathy in syringomyelia (G95.0) neuropathic spondylopathy in tabes dorsalis (A52.11) nonsyphilitic neuropathic spondylopathy NEC (G98.0) spondylitis in syphilis (acquired) (A52.77) tuberculous spondylitis (A18.01) typhoid fever spondylitis (A01.05)
Other dorsopathies (M50-M54) Excludes1: current injury – see injury of spine by body region discitis NOS (M46.4-)
M54.1 Radiculopathy Brachial neuritis or radiculitis NOS Lumbar neuritis or radiculitis NOS Lumbosacral neuritis or radiculitis NOS Thoracic neuritis or radiculitis NOS Radiculitis NOS Excludes1: neuralgia and neuritis NOS (M79.2) radiculopathy with cervical disc disorder (M50.1) radiculopathy with lumbar and other intervertebral disc disorder (M51.1-) radiculopathy with spondylosis (M47.2-)
Soft tissue disorders (M60-M79)
Disorders of muscles (M60-M63) Excludes1: dermatopolymyositis (M33.-) muscular dystrophies and myopathies (G71-G72) myopathy in amyloidosis (E85.-) myopathy in polyarteritis nodosa (M30.0) myopathy in rheumatoid arthritis (M05.32) myopathy in scleroderma (M34.-) myopathy in Sjögren’s syndrome (M35.03) myopathy in systemic lupus erythematosus (M32.-)
M60.0 Infective myositis Tropical pyomyositis Use additional code (B95-B97) to identify infectious agent
M60.2 Foreign body granuloma of soft tissue, not elsewhere classified Use additional code to identify the type of retained foreign body (Z18.-) Excludes1: foreign body granuloma of skin and subcutaneous tissue (L92.3)
M61.4 Other calcification of muscle Excludes1: calcific tendinitis NOS (M65.2-) calcific tendinitis of shoulder (M75.3)
M62 Other disorders of muscle Excludes1: alcoholic myopathy (G72.1) cramp and spasm (R25.2) drug-induced myopathy (G72.0) myalgia (M79.1) stiff-man syndrome (G25.82) Excludes2: nontraumatic hematoma of muscle (M79.81)
M62.1 Other rupture of muscle (nontraumatic) Excludes1: traumatic rupture of muscle – see strain of muscle by body region Excludes2: rupture of tendon (M66.-)
M62.4 Contracture of muscle Contracture of tendon (sheath) Excludes1: contracture of joint (M24.5-)
M62.5 Muscle wasting and atrophy, not elsewhere classified Disuse atrophy NEC Excludes1: neuralgic amyotrophy (G54.5) progressive muscular atrophy (G12.29) Excludes2: pelvic muscle wasting (N81.84)
M62.8 Other specified disorders of muscle Excludes2: nontraumatic hematoma of muscle (M79.81)
M63 Disorders of muscle in diseases classified elsewhere Code first underlying disease, such as: leprosy (A30.-) neoplasm (C49.-, C79.89, D21.-, D48.1) schistosomiasis (B65.-) trichinellosis (B75) Excludes1: myopathy in cysticercosis (B69.81) myopathy in endocrine diseases (G73.7) myopathy in metabolic diseases (G73.7) myopathy in sarcoidosis (D86.87) myopathy in secondary syphilis (A51.49) myopathy in syphilis (late) (A52.78) myopathy in toxoplasmosis (B58.82) myopathy in tuberculosis (A18.09)
Disorders of synovium and tendon (M65-M67)
M65 Synovitis and tenosynovitis Excludes1: chronic crepitant synovitis of hand and wrist (M70.0-) current injury – see injury of ligament or tendon by body region soft tissue disorders related to use, overuse and pressure (M70.-)
M65.2 Calcific tendinitis Excludes1: tendinitis as classified in M75-M77 calcified tendinitis of shoulder (M75.3)
M66 Spontaneous rupture of synovium and tendon Includes: rupture that occurs when a normal force is applied to tissues that are inferred to have less than normalstrength Excludes2: rotator cuff syndrome (M75.1-) rupture where an abnormal force is applied to normal tissue – see injury of tendon by body region
M67 Other disorders of synovium and tendon Excludes1: palmar fascial fibromatosis [Dupuytren] (M72.0) tendinitis NOS (M77.9-) xanthomatosis localized to tendons (E78.2)
M67.2 Synovial hypertrophy, not elsewhere classified Excludes1: villonodular synovitis (pigmented) (M12.2-)
M67.3 Transient synovitis Toxic synovitis Excludes1: palindromic rheumatism (M12.3-)
M67.4 Ganglion Ganglion of joint or tendon (sheath) Excludes1: ganglion in yaws (A66.6) Excludes2: cyst of bursa (M71.2-M71.3) cyst of synovium (M71.2-M71.3)
Other soft tissue disorders (M70-M79)
M70 Soft tissue disorders related to use, overuse and pressure Includes: soft tissue disorders of occupational origin Use additional external cause code to identify activity causing disorder (Y93.-) Excludes1: bursitis NOS (M71.9-) Excludes2: bursitis of shoulder (M75.5) enthesopathies (M76-M77) pressure ulcer (pressure area) (L89.-)
M71 Other bursopathies Excludes1: bunion (M20.1) bursitis related to use, overuse or pressure (M70.-) enthesopathies (M76-M77)
M76 Enthesopathies, lower limb, excluding foot Excludes2: bursitis due to use, overuse and pressure (M70.-) enthesopathies of ankle and foot (M77.5-)
M77 Other enthesopathies Excludes1: bursitis NOS (M71.9-) Excludes2: bursitis due to use, overuse and pressure (M70.-) osteophyte (M25.7) spinal enthesopathy (M46.0-)
M79 Other and unspecified soft tissue disorders, not elsewhere classified Excludes1: psychogenic rheumatism (F45.8) soft tissue pain, psychogenic (F45.41)
M79.6 Pain in limb, hand, foot, fingers and toes Excludes2: pain in joint (M25.5-)
M79.A Nontraumatic compartment syndrome Code first, if applicable, associated postprocedural complication Excludes1: compartment syndrome NOS (T79.A-) fibromyalgia (M79.7) nontraumatic ischemic infarction of muscle (M62.2-) traumatic compartment syndrome (T79.A-)
Osteopathies and chondropathies (M80-M94)
Disorders of bone density and structure (M80-M85)
M80 Osteoporosis with current pathological fracture Includes: osteoporosis with current fragility fracture Use additional code to identify major osseous defect, if applicable (M89.7-) Excludes1: collapsed vertebra NOS (M48.5) pathological fracture NOS (M84.4) wedging of vertebra NOS (M48.5) Excludes2: personal history of (healed) osteoporosis fracture (Z87.310) The appropriate 7th character is to be added to each code from category M80: A – initial encounter for fracture D – subsequent encounter for fracture with routine healing G – subsequent encounter for fracture with delayed healing K – subsequent encounter for fracture with nonunion P – subsequent encounter for fracture with malunion S – sequela
M81 Osteoporosis without current pathological fracture Use additional code to identify: major osseous defect, if applicable (M89.7-) personal history of (healed) osteoporosis fracture, if applicable (Z87.310) Excludes1: osteoporosis with current pathological fracture (M80.-) Sudeck’s atrophy (M89.0)
M84.3 Stress fracture Fatigue fracture March fracture Stress fracture NOS Stress reaction Use additional external cause code(s) to identify the cause of the stress fracture Excludes1: pathological fracture NOS (M84.4.-) pathological fracture due to osteoporosis (M80.-) traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-) Excludes2:personal history of (healed) stress (fatigue) fracture (Z87.312) stress fracture of vertebra (M48.4-) The appropriate 7th character is to be added to each code from subcategory M84.3: A – initial encounter for fracture D – subsequent encounter for fracture with routine healing G – subsequent encounter for fracture with delayed healing K – subsequent encounter for fracture with nonunion P – subsequent encounter for fracture with malunion S – sequela
M84.4 Pathological fracture, not elsewhere classified Chronic fracture Pathological fracture NOS Excludes1: collapsed vertebra NEC (M48.5) pathological fracture in neoplastic disease (M84.5-) pathological fracture in osteoporosis (M80.-) pathological fracture in other disease (M84.6-) stress fracture (M84.3-) traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-) Excludes2: personal history of (healed) pathological fracture (Z87.311) The appropriate 7th character is to be added to each code from subcategory M84.4: A – initial encounter for fracture D – subsequent encounter for fracture with routine healing G – subsequent encounter for fracture with delayed healing K – subsequent encounter for fracture with nonunion P – subsequent encounter for fracture with malunion S – sequela
M84.5 Pathological fracture in neoplastic disease Code also underlying neoplasm The appropriate 7th character is to be added to each code from subcategory M84.5: A – initial encounter for fracture D – subsequent encounter for fracture with routine healing G – subsequent encounter for fracture with delayed healing K – subsequent encounter for fracture with nonunion P – subsequent encounter for fracture with malunion S – sequela
M84.6 Pathological fracture in other disease Code also underlying condition Excludes1: pathological fracture in osteoporosis (M80.-) The appropriate 7th character is to be added to each code from subcategory M84.6: A – initial encounter for fracture D – subsequent encounter for fracture with routine healing G – subsequent encounter for fracture with delayed healing K – subsequent encounter for fracture with nonunion P – subsequent encounter for fracture with malunion S – sequela
M85 Other disorders of bone density and structure Excludes1: osteogenesis imperfecta (Q78.0) osteopetrosis (Q78.2) osteopoikilosis (Q78.8) polyostotic fibrous dysplasia (Q78.1)
Other osteopathies (M86-M90) Excludes1: postprocedural osteopathies (M96.-)
M86 Osteomyelitis Use additional code (B95-B97) to identify infectious agent Use additional code to identify major osseous defect, if applicable (M89.7-) Excludes1: osteomyelitis due to: echinococcus (B67.2) gonococcus (A54.43) salmonella (A02.24) Excludes2: ostemyelitis of: orbit (H05.0-) petrous bone (H70.2-) vertebra (M46.2-)
M87 Osteonecrosis Includes avascular necrosis of bone Use additional code to identify major osseous defect, if applicable (M89.7-) Excludes1: juvenile osteonecrosis (M91-M92) osteochondropathies (M90-M93)
M89 Other disorders of bone
M89.0 Algoneurodystrophy Shoulder-hand syndrome Sudeck’s atrophy Excludes1: causalgia, lower limb (G57.7-) causalgia, upper limb (G56.4-) complex regional pain syndrome II, lower limb (G57.7-) complex regional pain syndrome II, upper limb (G56.4-) reflex sympathetic dystrophy (G90.5-)
M89.5 Osteolysis Use additional code to identify major osseous defect, if applicable (M89.7-) Excludes2:periprosthetic osteolysis of internal prosthetic joint (T84.05-)
M89.7 Major osseous defect Code first underlying disease, if known, such as: aseptic necrosis of bone (M87.-) malignant neoplasm of bone (C40.-) osteolysis (M89.5) osteomyelitis (M86.-) osteonecrosis (M87.-) osteoporosis (M80.-, M81.-) periprosthetic osteolysis (T84.05-)
M90 Osteopathies in diseases classified elsewhere Excludes1: osteochondritis, osteomyelitis, and osteopathy (in): cryptococcosis (B45.3) diabetes mellitus (E08-E13 with .61-) gonococcal (A54.43) neurogenic syphilis (A52.11) renal osteodystrophy (N25.0) salmonellosis (A02.24) secondary syphilis (A51.46) syphilis (late) (A52.77)
Chondropathies (M91-M94) Excludes1: postprocedural chondropathies (M96.-)
M93.9 Osteochondropathy, unspecified Apophysitis NOS Epiphysitis NOS Osteochondritis NOS Osteochondrosis NOS
Other disorders of the musculoskeletal system and connective tissue (M95)
M95 Other acquired deformities of musculoskeletal system and connective tissue Excludes2: acquired absence of limbs and organs (Z89-Z90) acquired deformities of limbs (M20-M21) congenital malformations and deformations of the musculoskeletal system (Q65-Q79) deforming dorsopathies (M40-M43) dentofacial anomalies [including malocclusion] (M26.-) postprocedural musculoskeletal disorders (M96.-)
Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhereclassified (M96)
M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhereclassified Excludes2: arthropathy following intestinal bypass (M02.0-) complications of internal orthopedic prosthetic devices, implants and grafts (T84.-) disorders associated with osteoporosis (M80) presence of functional implants and other devices (Z96-Z97)
M96.6 Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate Intraoperative fracture of bone during insertion of orthopedic implant, joint prosthesis, or bone plate Excludes2: complication of internal orthopedic devices, implants or grafts (T84.-)
Biomechanical lesions, not elsewhere classified (M99)
M99 Biomechanical lesions, not elsewhere classified Note: This category should not be used if the condition can be classified elsewhere.