ICD-10 Codes to Report Dermatitis and Eczema [Infographic]

ICD-10 Codes to Report Dermatitis and Eczema [Infographic]

Eczema or atopic dermatitis (AD) is a chronic skin condition that causes red, itchy and inflamed patches on the skin, and is more common among children. Key factors that make eczema worse include dry skin, infection from bacteria and viruses, chemical irritants, etc. Atopic dermatitis is the most common type. Other types include hand eczema, contact dermatitis, dyshidrotic eczema, and nummular dermatitis. Though there is no specific cure for the condition, timely treatment combined with proper self-care measures can help reduce the itching in the long run. A combination of therapies such as medication, skincare, and lifestyle changes may be recommended.

Billing and coding for inflammatory skin conditions can be complex, as there are several associated codes. Dermatologists can rely on professional medical coding outsourcing companies to ensure accurate coding and timely claim filing for appropriate reimbursement.

Check out the infographic below for the Eczema ICD-10 codes

ICD-10 Codes to Report Dermatitis and Eczema

Common Lung Conditions and Their ICD-10 Codes  [Infographic]

Common Lung Conditions and Their ICD-10 Codes [Infographic]

Lung diseases include many conditions such as lung cancer, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, chronic bronchitis, emphysema, interstitial lung disease, asthma, and infections such as influenza, pneumonia, and tuberculosis. Pulmonologists are specialized in diagnosing and treating such diseases related to the respiratory system. Pulmonary medical coding involves submitting error-free medical claims to get the right reimbursement on-time.

Each year, October is observed as Healthy Lung Month to raise awareness about lung disease and the importance of protecting the lungs. Common symptoms of lung disease include chronic cough, chest pain, shortness of breath without any physical exertion, chronic mucus production, and wheezing. Based on the symptoms and diagnosis, doctors might recommend a lung test, bronchoscopy, CT scan, lung biopsy, exhaled nitric oxide test or more. Diagnoses should be documented using the right ICD-10 codes.

Check out the infographic below

Common Lung Conditions and Their ICD-10 Codes

How to Code for Gingivitis Using ICD-10 Medical Codes

How to Code for Gingivitis Using ICD-10 Medical Codes

Gingivitis is a common form of gum disease that causes swelling, redness and irritation of gingiva – the part of your gum around the base of your teeth. One of the most common causes of gingivitis is poor oral hygiene. Poor oral health habits often leads to build-up of plaque (a naturally-occurring sticky film containing bacteria) on the surface of teeth that causes inflammation of the surrounding gum tissue. Plaque produces toxins that irritate the gums causing severe inflammation and making them red or puffy eventually causing bleeding when a person brushes his/her teeth. As plaque advances, it hardens and becomes tartar. Plaque can develop into an infection when it extends below the gum line. If left untreated, this condition can progress to gum disease that spreads to underlying tissue and bone (periodontitis), a much more serious condition that can lead to tooth loss. In addition, chronic gingiva inflammation has been thought to have direct association with some systemic diseases such as respiratory disease, diabetes, coronary artery disease, stroke and rheumatoid arthritis. Early identification of symptoms and risk factors that directly contribute to this gum disease can help prevent the condition in the long run. As dental medical billing and coding involves several complexities, physicians must have knowledgeable teams and business systems in place to correctly document the procedures performed. Medical billing outsourcing is an option worth considering as this can help physicians ensure accurate and timely claim filing and reimbursement.

According to the American Dental Association, gingivitis and periodontitis are the major causes of tooth loss in adults. It is estimated that this gum condition occurs in 3 out of 4 Americans during their lifetime. However, with early and proper dental care, many of its symptoms can be easily reversed. Good oral health habits, such as brushing at least twice a day, flossing daily and getting regular dental checkups, can help prevent and reverse the symptoms of gingivitis.

Classic Symptoms of Gingivitis

Generally, many people aren’t aware that they have gingivitis. In most cases, this gum disease occurs without any specific symptoms. In mild cases of gingivitis, there may be no discomfort or noticeable symptoms. Common signs and symptoms include –

  • Bright red or purple gums
  • Tender gums that may be painful to the touch
  • Receding and soft gums
  • Pus between teeth and gums
  • Inflammation or swollen gums
  • Halitosis or bad breath
  • Bleeding from the gums when brushing or flossing
  • A change in how your teeth fit together when you bite (malocclusion)

Reports from the Centers for Disease Control and Prevention and the National Institute of Dental and Craniofacial Research suggest that gingivitis is associated with an increased risk of diabetes, heart disease, stroke, and lung disease. It also increases the risk of a woman giving birth to a premature or low birth weight infant.

Several factors that can increase your risk of gingivitis include – smoking or chewing tobacco, dry mouth, crooked teeth, dental restorations (that don’t fit properly), use of certain medications (oral contraceptives, steroids, anticonvulsants, calcium channel blockers, and chemotherapy) and hormonal changes.

How Is Gingivitis Diagnosed and Treated?

Initial diagnosis of gingivitis may begin with a detailed review of dental and medical history and conditions that may contribute to your symptoms. The dentist or periodontist would conduct a detailed examination of your teeth, gums, mouth and tongue for signs of plaque and inflammation. They will probe your gums with a small ruler and measure any pockets around your teeth. In addition, your dentist may also order imaging tests like X-rays to check for bone loss.

Regular and timely treatment help to reverse the symptoms of this gum condition and prevent it from progressing to a more serious gum disease and tooth loss. Treatment modalities for this condition include – deep cleaning your teeth, antibiotic medications and surgery.

Professional dental cleaning removes all traces of plaque, tartar and bacterial products – a procedure called scaling and root planning. Scaling removes tartar and bacteria from tooth surfaces. Root planning on the other hand, removes the bacterial products produced by inflammation, softens the root surfaces and prevents further buildup of tartar and bacteria. Root planning procedure may be performed using laser technique or an ultrasonic device. Lasers may remove tartar with less pain and bleeding than scaling and root planning. Dental restoration may be done to fix misaligned teeth or poorly fitting crowns, or bridges that irritate your gums and make it harder to remove plaque during daily oral care. Medications include – Antiseptic mouthwash, Oral antibiotics, Doxycycline and timed-release antiseptic chips containing chlorhexidine can be inserted into pockets after root planing.

Surgery will be considered as a last resort if the above non-surgical treatment methods are not effective. Surgical techniques include – flap surgery (a procedure where the gums are lifted back while plaque and tartar is removed from deeper pockets), soft tissue grafts (can be used when teeth and jaw are too damaged to heal), and bone grafting.

Dental medical coding involves using the specific ICD-10 diagnosis codes to report various dental conditions such as gingivitis on the medical claims providers submit to health insurers. Dentists or periodontists who perform dental surgery need to submit accurate documentation that meets payer guidelines. Therefore, in addition to medical billing and coding services, dental insurance verification and pre-authorization services are crucial to verify patient’s coverage.

ICD-10 Codes to Use

  • K05 – Gingivitis and periodontal diseases
  • K05.0 – Acute gingivitis
    • K05.00 – Acute gingivitis, plaque induced
    • K05.01 – Acute gingivitis, non-plaque induced
  • K05.1 – Chronic gingivitis
    • K05.10 – Chronic gingivitis, plaque induced
    • K05.11 – Chronic gingivitis, non-plaque induced

Preventing Gingivitis

Practicing proper and consistent oral hygiene is one of the primary steps to prevent the occurrence of gingivitis. Make a habit to brush your teeth twice daily with fluoride toothpaste. Floss your teeth every day. Eat a balanced diet and get regular professional dental cleanings on a schedule recommended by your dentist. Other prevention strategies include – cut back on smoking or chewing tobacco, use a mouth rinse to help reduce plaque, supplement brushing and flossing with an interdental cleaner, (such as a dental pick, interdental brush or dental stick) specially designed to clean between your teeth.

Medical coding for gum disorders can be a challenging process. For accurate and timely medical billing and claims submission, healthcare practices can outsource their medical coding tasks to a medical billing company that provides the services of AAPC-certified coding specialists.

Reporting and Coding Different Types of Hernia

Hernia is a common problem which causes a localized bulge in the abdomen or groin. The condition occurs when there is a weakness or hole in the peritoneum – the muscular wall that usually keeps abdominal organs in place. This weakness in the peritoneumallows organs and tissues to push through, or herniate, producing a bulge. Generally, a hernia develops between your chest and hips. The condition causes very few symptoms or sometimes no symptoms at all, although in some cases you may notice a swelling or lump in your tummy (abdomen) or groin. The lump may disappear when you lie down, and sometimes it can be pushed back. Coughing or straining may make it reappear.Most hernias aren’t immediately life threatening, but they don’t improve on their own and can lead to severe, life-threatening complications. Medications and self-care measures can help reduce the immediate symptoms to some extent. Physicians, in most cases will recommend surgery to fix a hernia that’s painful or enlarging. As reimbursement rules, regulations, and payer policiesare subjected to changes frequently, partnering with an experienced medical billing and coding company is the best option to ensure clean and accurate claims for hernia surgery.

One of the common symptoms associated with the condition is a bulge or painless lump in the affected area. However, the condition may be the cause of serious discomfort and pain, with symptoms often becoming worse when standing, straining or lifting heavy items. Other associated symptoms include sudden, severe pain or discomfort in the affected area (especially when bending over, coughing, or lifting), nausea, vomiting, constipation, a feeling of pressure/heaviness in the abdomen, aburning, gurgling, or aching sensation at the site of the bulge, chest pain, acid reflex and difficulty swallowing.

Types of Hernia

  • Inguinal hernia – This is one of the most common types of hernia which mainly affects men. It occurs when the intestines push through a weak spot or tear in the lower abdominal wall, often in the inguinal canal.
  • Hiatal hernia – This condition is most common in people over 50 years old. It occurs when part of your stomach protrudes up through the diaphragm into your chest cavity.
  • Umbilical hernia – This condition occurs when the intestines bulge through their abdominal wall near the belly button. It is more common among babies below 6 months. This is the only type of hernia that often goes away on its own as the abdominal wall muscles get stronger, typically by the time the child becomes 1 year old.
  • Femoral hernia –This type occurs when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh.
  • Incisional/ventral hernia – The condition arises when tissue pokes through a surgical wound in your abdomen that hasn’t fully healed.
  • Epigastric hernia – It occurs when fatty tissue pokes through your abdomen, between your navel and the lower part of your breastbone (sternum).
  • Diaphragmatic hernia – This type of hernia occurs when organs in your abdomen move into your chest through an opening in the diaphragm. This condition can also affect babies if their diaphragm doesn’t develop properly in the womb.

There is no specific cause or reason for a hernia to occur (except the case of incisional hernia that occurs due to a complication of abdominal surgery). They are generally caused by a combination of muscle weakness and strain. The condition occurs more commonly in men than in women and the risks increases with age. Other factors that increase your risk of developing a hernia include family history of the condition, obesity, chronic cough, constipation and conditions like cystic fibrosis, enlarged prostate, peritoneal dialysis, abdominal fluid and undescended testicles.

Diagnosis and Treatment Methods

Hernias are usually diagnosed through a detailed physical examination wherein your physician may feel for a bulge in the abdomen or groin that gets larger when you stand, cough or strain. Diagnostic imaging tests like X-ray, Ultrasound and Endoscopy may be conducted to correctly diagnose the symptoms and determine the exact type of hernia.

Treatment options for this condition depend on the size and type of hernia and the severity of your symptoms. Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.There are two main types of surgical intervention for hernia –open surgery and laparoscopic operation (keyhole surgery). In the case of open surgery, the surgeon makes an incision and pushes the protruding tissue back into your abdomen. On the other hand, laparoscopic is a less invasive technique where several small incisions are made in your abdomen, thereby allowing the surgeon to use various special instruments to repair the hernia.

General surgery medical coding involves using the specific ICD-10 diagnosis codes, CPT procedure codes, HCPCS codes and MS-DRG codes for reporting hernia on your medical claims.

ICD -10 Codes to Indicate a Diagnosis of Hernia

K40 – Inguinal hernia

  • K40.0 – Bilateral inguinal hernia, with obstruction, without gangrene
  • K40.1 – Bilateral inguinal hernia, with gangrene
  • K40.2 – Bilateral inguinal hernia, without obstruction or gangrene
  • K40.3 – Unilateral inguinal hernia, with obstruction, without gangrene
  • K40.4 – Unilateral inguinal hernia, with gangrene
  • K40.9 – Unilateral inguinal hernia, without obstruction or gangrene

K41 – Femoral hernia

  • K41.0 – Bilateral femoral hernia, with obstruction, without gangrene
  • K41.1 – Bilateral femoral hernia, with gangrene
  • K41.2 – Bilateral femoral hernia, without obstruction or gangrene
  • K41.3- Unilateral femoral hernia, with obstruction, without gangrene
  • K41.4 – Unilateral femoral hernia, with gangrene
  • K41.9 – Unilateral femoral hernia, without obstruction or gangrene

K42 – Umbilical hernia

  • K42.0 – Umbilical hernia with obstruction, without gangrene
  • K42.1 – Umbilical hernia with gangrene
  • K42.9 – Umbilical hernia without obstruction or gangrene

K43 – Ventral hernia

  • K43.0 – Incisional hernia with obstruction, without gangrene
  • K43.1 – Incisional hernia with gangrene
  • K43.2 – Incisional hernia without obstruction or gangrene
  • K43.3 – Parastomal hernia with obstruction, without gangrene
  • K43.4 – Parastomal hernia with gangrene
  • K43.5 – Parastomal hernia without obstruction or gangrene
  • K43.6 – Other and unspecified ventral hernia with obstruction, without gangrene
  • K43.7 – Other and unspecified ventral hernia with gangrene
  • K43.9 – Ventral hernia without obstruction or gangrene

K44 – Diaphragmatic hernia

  • K44.0 – Diaphragmatic hernia with obstruction, without gangrene
  • K44.1 – Diaphragmatic hernia with gangrene
  • K44.9 – Diaphragmatic hernia without obstruction or gangrene

K45 – Other abdominal hernia

  • K45.0 – Other specified abdominal hernia with obstruction, without gangrene
  • K45.1 – Other specified abdominal hernia with gangrene
  • K45.8 – Other specified abdominal hernia without obstruction or gangrene

K46 – Unspecified abdominal hernia

  • K46.0 – Unspecified abdominal hernia with obstruction, without gangrene
  • K46.1 – Unspecified abdominal hernia with gangrene
  • K46.9 – Unspecified abdominal hernia without obstruction or gangrene

CPT Codes

Inguinal Hernia

  • 49492 – Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks post conception age, with or without hydrocelectomy; incarcerated or strangulated
  • 49495 – Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible
  • 49496 – Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated
  • 49500 – Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible
  • 49501 – Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated
  • 49505 – Repair initial inguinal hernia, age 5 years or older; reducible
  • 49507 – Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated
  • 49520 – Repair recurrent inguinal hernia, any age; reducible
  • 49521 – Repair recurrent inguinal hernia, any age; incarcerated or strangulated
  • 49525 – Repair inguinal hernia, sliding, any age
  • 49650 – Laparoscopy, surgical; repair initial inguinal hernia
  • 49651 – Laparoscopy, surgical; repair recurrent inguinal hernia

Hiatal Hernia

  • 43332 – Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis
  • 43333 – Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis
  • 43334 – Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis
  • 43335 – Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis
  • 43336 – Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis
  • 43337 – Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis

Umbilical Hernia

  • 49580 – Repair umbilical hernia, younger than age 5 years; reducible
  • 49582 – Repair umbilical hernia, younger than age 5 years; incarcerated or strangulated
  • 49585 – Repair umbilical hernia, age 5 years or older; reducible
  • 49587 – Repair umbilical hernia, age 5 years or older; incarcerated or reducible

Femoral Hernia

  • 49550 – Repair initial femoral hernia, any age; reducible
  • 49553 – Repair initial femoral hernia, any age; incarcerated or strangulated
  • 49555 – Repair recurrent femoral hernia; reducible
  • 49557 – Repair recurrent femoral hernia; incarcerated or strangulated

Incisional/Ventral Hernia

  • 49560 – Repair initial incisional or ventral hernia; reducible
  • 49561 – Repair initial incisional or ventral hernia; incarcerated or strangulated
  • 49565 – Repair recurrent incisional or ventral hernia; reducible
  • 49566 – Repair recurrent incisional or ventral hernia; incarcerated or strangulated
  • +49568 – Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)
  • 49652 – Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible
  • 49653 – Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated
  • 49654 – Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible
  • 49655 – Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated
  • 49656 – Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible
  • 49657 – Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

Epigastric Hernia

  • 49570 – Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)
  • 49572 – Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated

Diaphragmatic Hernia

  • 39501 – Repair, laceration of diaphragm, any approach
  • 39503 – Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia
  • 39541 – Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic

HCPCS Codes

  • C1726 – Catheter, balloon dilatation, non-vascular
  • C1781 – Mesh (implantable)
  • C9364 – Porcine implant, permacol, per square centimeter

MS-DRG Codes

Repair of Diaphragmatic Hernia (Hiatal Hernia, Paraesophageal Hernia)

  • 326 – Stomach, Esophageal and Duodenal Procedures W MCC
  • 327 – Stomach, Esophageal and Duodenal Procedures W CC
  • 328 – Stomach, Esophageal and Duodenal Procedures W/O CC/MCC

Hernia Repair – Inguinal, Femoral

  • 350 – Inguinal and Femoral Hernia Procedures W MCC
  • 351 – Inguinal and Femoral Hernia Procedures W CC
  • 352 – Inguinal and Femoral Hernia Procedures W/O CC/MCC

Hernia Repair – Other (Epigastric, Incisional/Ventral, Lumbar, Parastomal, Spigelian, Umbilical)

  • 353 – Hernia Procedures Except Inguinal and Femoral W MCC
  • 354 – Hernia Procedures Except Inguinal and Femoral W CC
  • 355 – Hernia Procedures Except Inguinal and Femoral W/O CC/MCC

Integrating positive lifestyle habits can help treat the symptoms of hernia in the long run. These include – making dietary changes, avoiding large or heavy meals, stopping the habit of smoking and doing certain kind of exercises (that help strengthen the muscles around the hernia site) and maintaining a healthy body weight.

Medical billing and coding requires knowledge regarding the right coding modifiers and payer-specific medical billing are essential for correct and on-time reimbursement. With all the complexities involved, the support of a reliable and experienced medical coding service provider can be useful for reporting hernia surgical repair procedure correctly.

Osteomyelitis Coding in ICD-10 — Ensure Specificity

Osteomyelitis Coding in ICD-10 — Ensure Specificity

Osteomyelitis is an infection in the bone. The infection can spread from nearby tissue or originate in the bone itself if a fracture or other trauma exposes the bone to infection. Osteomyelitis can be classified as acute, sub-acute, and chronic. Compared to ICD-9, there are specific guidelines and codes for reporting osteomyelitis in ICD-10 where acute, sub-acute and chronic osteomyelitis are grouped into additional subcategories. Further, ICD-10 differentiates between sub-acute infections and acute infections which have their own subcategories. Expert coders in medical coding companies can help physicians report osteomyelitis using appropriate ICD-10 codes based on the type, location, and acuity (acute, subacute, hematogenous, and/or chronic).

Causes and Risk Factors

Osteomyelitis is caused by an infecting organism, typically staphylococcus bacteria. Trauma, surgery, the presence of foreign bodies, or the placement of prostheses can compromise bone integrity and cause bone infection to develop. Osteomyelitis can also occur when infections reach the bone through the bloodstream. People with chronic health conditions such as diabetes mellitus and peripheral vascular disease, and smokers have a higher risk of developing chronic osteomyelitis. In children, osteomyelitis appears in the arm or leg bone.

Symptoms

Signs of osteomyelitis include fever, swelling, warmth and pain in the area of the infection, and fatigue. However, the condition can manifest without symptoms in infants, older adults and people whose immune systems are compromised.

Osteomyelitis – Types

Acute osteomyelitis is characterized by localized pain, soft-tissue swelling, and tissue warmth at the site of the infection as well as typical symptoms such as fever, irritability, fatigue, and nausea. It is easier to treat

In sub-acute osteomyelitis, symptoms are less severe than acute osteomyelitis and develop at a less rapid pace. Sub-acute osteomyelitis may be characterized by only moderate, localized pain without any systemic issues.

Chronic osteomyelitis is a severe, persistent inflammation/infection that is difficult to treat and can recur. A chronic infection also may be accompanied by a draining sinus, involving a higher risk for complications. Chronic multifocal osteomyelitis (chronic recurrent multifocal osteomyelitis) is a rare condition that mainly affects children. Symptoms include bone inflammation in multiple areas, severe pain, fever gait problems, and even skin changes.

ICD-10 codes to Report Osteomyelitis

In ICD-10, the codes to report osteomyelitis are in the M86-series. An ICD-10 Monitor article explains the circumstances for using these codes:

Acute and sub-acute osteomyelitis: There are three subcategories for reporting acute and sub-acute osteomyelitis using ICD-10 (including M86.0 to M86.2). Codes from subcategory M86.1 are used to report direct inoculation osteomyelitis.

Chronic osteomyelitis: There are four subcategories for reporting chronic osteomyelitis (including M86.3 to M86.6).

Other osteomyelitis: In ICD-10, 8 reports other osteomyelitis and are two additional subcategories for the reporting this condition. Currently regarded as a sub-acute condition, Brodie’s abscess is characterized by the presence of a bone abscess surrounded by dense fibrous tissue and sclerotic bone. Unspecified osteomyelitis is reported by subcategory M86.9.

M86 Osteomyelitis
M86.0 Acute hematogenous osteomyelitis
M86.1 Other acute osteomyelitis
M86.2 Subacute osteomyelitis
M86.3 Chronic multifocal osteomyelitis
M86.4 Chronic osteomyelitis with draining sinus
M86.5 Other chronic hematogenous osteomyelitis
M86.6 Other chronic osteomyelitis
M86.8 Other osteomyelitis
M86.9 Osteomyelitis, unspecified

Codes M86 to M86.8 are non-billable and coders must use specific codes that describe the diagnosis in more detail. Code M86.9 is a billable code that is valid for submission for HIPAA-covered transactions. M86.3 is a combination code that captures chronic types (in which a draining sinus is present).

Specific sites for subcategories M86.0-M86.6 include: Shoulder, Humerus, Radius/ulna, Hand, Femur, Tibia/fibula, Ankle/foot, Other specified sites, and Multiple sites. The following are examples of specific, billable codes that identify etiology, anatomic site, severity, and other details:

M86.061 acute hematogenous osteomyelitis, right tibia and fibula
M86.062 acute hematogenous osteomyelitis, left tibia and fibula
M86.131 other acute osteomyelitis, right radius and ulna
M86.132 other acute osteomyelitis, left radius and ulna
M86.241 subacute osteomyelitis, right hand
M86.242 subacute osteomyelitis, left hand
M86.371 chronic multifocal osteomyelitis, right ankle and foot
M86.372 chronic multifocal osteomyelitis, left ankle and foot

The ICD-10 Monitor article offers the following additional guidance for reporting osteomyelitis:

  • An additional code from categories B95-B97 should be assigned to identify the infectious agent.
  • A code from subcategory M89.7 should be reported to identify any major osseous defects.
  • In ICD-10, there is no separate designation for periostitis (inflammation of the membrane covering a bone) without mention of osteomyelitis. There are specific entries for periostitis of the dentoalveolar structures and jaw, and for periostitis due to certain infectious organisms, such as gonorrhea, syphilis, tuberculosis, and yaws. All other types are reported with a code from subcategory M86.0 along with a secondary code to identify the infectious organism.

With specific guidelines and additional code choices for osteomyelitis in ICD-10, reporting the condition correctly can be a challenge. Outsourcing medical coding and billing to an expert can ensure accurate coding and billing for error-free claim submission and optimal reimbursement.