Understanding Enthesopathy ICD-10 CM Coding

by | Published on Apr 22, 2016 | Medical Coding

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With ICD-10 codes, the need for outsourcing medical coding has become more important. The extensiveness of ICD-10 has made coding more confusing and laborious for physicians and practices. With EHR data entry also on the minds of doctors, they just have too much to think of that could take their mind away from the patient. A look into enthesopathy coding reveals the comprehensiveness of ICD-10 coding.

What Is Enthesopathy?

Enthesopathy is a condition where tendons, muscles or ligaments come into contact with the bones or joint capsules, resulting in inflammation, degeneration, and even affected function. Tendonitis and bursitis are two major kinds of enthesopathy.

  • As you know, tendonitis refers to a tendon getting inflamed as a result of repetitive action, which exerts greater pressure on the tendon. As the body continues to engage the tendon in activity, the natural repair processes get slowed down causing greater, tearing pain. Tendonitis usually occurs in joints such as the elbows, wrists, knees, shoulders, hips and heels. The likelihood for this condition increases with age.
  • Bursitis refers to a condition that affects the bursae. It is the result of repetitive motions irritating the bursae. It can also be caused by sudden injury bringing about a minor impact resulting in the inflammation of the bursae.

Coding for Various Enthesopathy Conditions

Clinical documentation for enthesopathy must include the kind of enthesopathy, the site of the occurrence, and the laterality for assigning the appropriate code. Here are the codes that are to be used to document enthesopathy conditions:

Bursitis of Shoulder

  • M75.50 – Bursitis affecting unspecified shoulder
  • M75.51 – Bursitis affecting right shoulder
  • M75.52 – Bursitis affecting left shoulder

Trochanteric Bursitis

  • M70.61 – Trochanteric bursitis affecting right hip
  • M70.62 – Trochanteric bursitis affecting left hip

Rheumatoid Bursitis

  • M06.20 – Rheumatoid bursitis affecting unspecified site
  • M06.21 – Rheumatoid bursitis affecting shoulder
  • M06.211 – Rheumatoid bursitis affecting right shoulder
  • M06.212 – Rheumatoid bursitis affecting left shoulder
  • M06.219 – Rheumatoid bursitis affecting unspecified shoulder
  • M06.22 – Rheumatoid bursitis affecting elbow
  • M06.221 – Rheumatoid bursitis of the right elbow
  • M06.222 – Rheumatoid bursitis of the left elbow
  • M06.229 – Rheumatoid bursitis affecting unspecified elbow
  • M06.24 – Rheumatoid bursitis affecting the hand
  • M06.241 – Rheumatoid bursitis of the right hand
  • M06.242 – Rheumatoid bursitis affecting the left hand
  • M06.249 – Rheumatoid bursitis of unspecified hand
  • M06.25 – Rheumatoid bursitis affecting the hip
  • M06.251 – Rheumatoid bursitis of the right hip
  • M06.252 – Rheumatoid bursitis of the left hip
  • M06.259 – Rheumatoid bursitis of unspecified hip
  • M06.26 – Rheumatoid bursitis of the knee
  • M06.261 – Rheumatoid bursitis affecting right knee
  • M06.262 – Rheumatoid bursitis affecting left knee
  • M06.269 – Rheumatoid bursitis of unspecified knee
  • M06.27 – Rheumatoid bursitis of ankle and foot
  • M06.271 – Rheumatoid bursitis affecting right ankle and foot
  • M06.272 – Rheumatoid bursitis of left ankle and foot
  • M06.279 – Rheumatoid bursitis of unspecified ankle and foot

Hand Bursitis and Olecranon Bursitis

  • M70.10 – Bursitis of hand
  • M70.20 – Olecranon bursitis
  • M70.21 – Olecranon bursitis affecting right elbow
  • M70.22 – Olecranon bursitis affecting left elbow
  • M70.30 – Other bursitis affecting the elbow

Prepatellar Bursitis

  • M70.41 – Prepatellar bursitis of the right knee
  • M70.42 – Prepatellar bursitis affecting the left knee
  • M70.50 – Other bursitis affecting the knee, unspecified knee
  • M70.51 – Other bursitis affecting the right knee
  • M50.52 – Other bursitis affecting the left knee
  • M70.70 – Other bursitis affecting the hip, unspecified hip
  • M70.71 – Other bursitis affecting the right hip
  • M70.72 – Other bursitis affecting the left hip

Spinal Enthesopathy

  • M46.01 – Spinal enthesopathy of the occipito-atlanto-axial region
  • M46.02 – Spinal enthesopathy of the cervical region
  • M46.03 – Spinal enthesopathy affecting the cervicothoracic region
  • M46.04 – Spinal enthesopathy of the thoracic region
  • M46.05 – Spinal enthesopathy affecting the thoracolumbar region
  • M46.06 – Spinal enthesopathy of the lumbar region
  • M46.07 – Spinal enthesopathy of the lumbosacral region
  • M46.08 – Spinal enthesopathy affecting the sacral and the sacroccygeal region
  • M46.09 – Spinal enthesopathy affecting multiple spinal sites

Trigger Finger

  • M65.30 – Trigger finger affecting unspecified finder
  • M65.331 – Trigger finger of the right middle finger
  • M65.332 – Trigger finger affecting left middle finger
  • M65.341 – Trigger finger of the right ring finger
  • M65.342 – Trigger finger of the left ring finger

This list of ICD-10 CM codes for most enthesopathy and bursitis conditions should give a clear picture as to how to code diagnosis of enthesopathy.

This list is also proof of how extensive ICD-10 coding is, particularly when contrasted with ICD-9. Each detail can now be described through codes, and it’s got to be perfect if your practice needs to be paid by the insurance provider for its services.

Outsourcing medical coding could bring about many benefits, particularly for small and mid-sized practices that cannot afford to keep dedicated coding staff on its payroll. And let’s not forget, now physicians are also burdened with entering data into the EHR. Reliable companies providing coding services also offer EHR data entry solutions which would help physicians focus on their patients more rather than worrying about the documentation.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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