Hemarthrosis is a condition that occurs as a result of bleeding into a joint cavity. Blood vessels inside the joint are damaged and bleed. The blood then collects in the joint space. Joints, also called articulations, are the connections between two bones that allow movement. Also known as articular bleeding, the joint condition can begin after a joint injury or it may develop spontaneously if you are prone to bleeding. Common causes include trauma or injury (like a sprain, fracture, or torn ligament), a bleeding disorder such as hemophilia, use of medications to prevent blood clots (blood thinners) such as warfarin, infections, osteoarthritis, neoplasms and arthroscopic surgery. The condition causes pain and swelling of the joint. If left untreated, hemarthrosis can inflame and thin the cartilage, causing pain, weakness, swelling, or additional bleeding into the joint resulting in permanent changes in joint structure and function. Medical specialists treating this condition can rely on reputable medical billing companies to meet their claim submission tasks and thus receive reimbursement on time.
A joint that has recurring hemarthrosis (bleeding episodes) is known as a target joint – which means or requires that around four separate bleeds must have occurred in the same joint within a six-month period. However, a target joint can also be caused by one severe bleed. The most common joints affected are the knees, ankles and elbows. In addition, it can also occur in the hip, shoulders and wrists.
Identify the Symptoms
Most people experience signs and symptoms of this condition much later in their life – usually between the ages of 50 and 60. Women are more likely to develop symptoms after menopause, when they no longer lose iron with menstruation and pregnancy. The signs and symptoms associated with the condition can range from mild to severe, and are generally worse if there is a large amount of bleeding. Common symptoms include –
- Tingling, aching, or bubbling sensation at the joint
- Pain or tenderness and swelling
- Joint redness and warmth
- Trouble moving the joint or joint stiffness
- Excessive bruising near the affected joint
- Decrease in range of motion (the joint can’t be fully extended or flexed)
- Red skin over the affected joint
The continuous bleeding can significantly damage the joint. In most cases, one severe bleed or a series of smaller bleeds can cause permanent damage. Eventually, the soft tissues, ligaments and tendons surrounding the joint shrink and lead to reduced range of motion in the joint.
How Is Articular Bleeding Diagnosed and Treated?
Diagnosis of articular bleeding will generally begin with a detailed evaluation of previous medical history. Physicians will begin the evaluation by asking questions about any specific joint condition and recent injuries the patient suffered and the medications consumed. Patients must communicate to their physician if they have a family history of a bleeding disorder.
Physicians will ask questions about the symptoms and conduct a detailed physical examination. They may move or bend the specific joint (where the patient experiences symptoms) in order to test its range of motion. A wide range of diagnostic tests such as blood tests (to measure the amount of clotting factor present) and imaging tests like X-rays and MRI will be conducted. In some cases, synovial fluid analysis will be done to diagnose the cause of joint inflammation. In this procedure, a needle will be inserted into the joint to draw fluid into a syringe (also called joint aspiration). Reddish-colored fluid could mean blood is present. The sample is then sent to a laboratory for further testing.
Treatment for hemarthrosis depends on the cause and may include simple at-home remedies, medication for pain relief and swelling, removal of the blood, and/or to prevent bleeding. The type of treatment depends on the underlying cause of the joint damage and the severity of the damage. Treatment options may generally include resting and icing the joint, elevating the affected limb, draining the blood from the joint and consuming pain medications such as Advil (ibuprofen) and Aleve (naproxen). Surgery to clean out or replace the joint will be considered as a last resort. There are two main types of surgery for treating hemarthrosis. The first one is synovectomy involving removal of the synovium, which is the lining of a joint. The secondary surgical option is joint replacement in which a surgeon completely removes the damaged joint and bone and replaces it with plastic and metal components. As an alternative to surgery, or after surgery for hemarthrosis, a person will need to undergo physical therapy – which will help in early recovery and prevent further joint deformities.
Orthopedics medical billing and coding can be challenging as it involves using several code categories. Physicians or spinal specialists who treat hemarthrosis must use the relevant ICD-10 codes to bill for the procedure. The medical codes used to report hemarthrosis include –
M25.0 – Hemarthrosis
- M25.00 – Hemarthrosis, unspecified joint
M25.01 – Hemarthrosis, shoulder
- M25.011 – Hemarthrosis, right shoulder
- M25.012 – Hemarthrosis, left shoulder
- M25.019 – Hemarthrosis, unspecified shoulder
M25.02 – Hemarthrosis, elbow
- M25.021 – Hemarthrosis, right elbow
- M25.022 – Hemarthrosis, left elbow
- M25.029 – Hemarthrosis, unspecified elbow
M25.03 – Hemarthrosis, wrist
- M25.031 – Hemarthrosis, right wrist
- M25.032 – Hemarthrosis, left wrist
- M25.039 – Hemarthrosis, unspecified wrist
M25.04 – Hemarthrosis, hand
- M25.041 – Hemarthrosis, right hand
- M25.042 – Hemarthrosis, left hand
- M25.049 – Hemarthrosis, unspecified hand
M25.05 – Hemarthrosis, hip
- M25.051 – Hemarthrosis, right hip
- M25.052 – Hemarthrosis, left hip
- M25.059 – Hemarthrosis, unspecified hip
M25.06 – Hemarthrosis, knee
- M25.061 – Hemarthrosis, right knee
- M25.062 – Hemarthrosis, left knee
- M25.069 – Hemarthrosis, unspecified knee
M25.07 – Hemarthrosis, ankle and foot
- M25.071 – Hemarthrosis, right ankle
- M25.072 – Hemarthrosis, left ankle
- M25.073 – Hemarthrosis, unspecified ankle
- M25.074 – Hemarthrosis, right foot
- M25.075 – Hemarthrosis, left foot
- M25.076 – Hemarthrosis, unspecified foot
Hemarthrosis is not a common condition, but it is important to know about the symptoms and other complications associated with the condition. Mild to moderate joint bleeding can resolve with time. However, patients having swelling of one or more joints in their body should immediately consult a pain management physician. Treatment can alleviate the pain, discomfort, and swelling and prevent long-term complications and joint damage. People who experience bleeding on a regular basis, or have a severe bleed that is not treated right away, can sustain permanent damage to the joint.
Knowing the highly specific ICD-10 codes related to documenting joint damages is critical for providers. Partnering with an experienced medical billing and coding company is important for physicians to ensure accurate and timely claim submissions.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.