ICD-10 Codes for Four Common Orthopedic Problems of the Elderly

ICD-10 Codes for Four Common Orthopedic Problems of the Elderly

The article lists the top four common orthopedic problems or injuries faced by the elderly along with its related ICD-10 codes.

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Musculoskeletal disorders and injuries (affecting the bones, joints and muscles) can be extremely painful and debilitating, affecting the day-to-day quality of life. Orthopedic problems are among the most serious disorders affecting aged/elderly Americans. With aging, the musculoskeletal tissues show increased bone fragility, loss of cartilage flexibility, reduced ligament elasticity and loss of muscular strength decreasing the ability of the tissues to carry out their normal functions. Around old age, our body begins to respond to wear and tear differently. Even a simple fall can cause a severe injury or fracture among elderly people. The loss of mobility and physical independence resulting from these musculoskeletal injuries or conditions can be life-threatening, particularly for this population group. Reports from the American Academy of Orthopedic Surgeons (2019 survey) suggest that orthopedic complaints are the most common reason that force elderly Americans to seek immediate medical care. It is estimated that one in seven Americans have an orthopedic impairment. Treatment modalities for common orthopedic disorders include pain medications (such as anti-inflammatories, pain relievers, or muscle relaxers), injections (like corticosteroids or nerve blocks), braces and splint supports and rehabilitation techniques to strengthen and stretch the joints and muscles. Surgery to replace joints or repair nerves will be considered if the condition does not resolve with non-operative treatments. Orthopedic practices dealing with patients suffering from musculoskeletal disorders need to use the correct ICD-10 codes to report these conditions. Relying on the services of an established orthopedics medical billing company can help in accurate and timely claim submission for appropriate reimbursement.

Let’s take a look at the ICD-10 codes for four common orthopedic problems faced by older adults – Osteoarthritis (OA) – Regarded as one of the most common form of arthritis affecting millions of people worldwide, osteoarthritis (OA) occurs when the protective cartilage that cushions the ends of your bones wears down over time. Although OA can affect people of any age group, this condition tend to be more common among older people. According to reports, OA affects more than 30 million men and women in the United States (2019 statistics). The condition can occur in any joint. However, the most commonly affected areas of the body include the hands, fingertips, knees, hips and spine, typically at the neck or lower back. Symptoms of OA often develop slowly and worsen over time. Common symptoms include pain, tenderness (discomfort when pressing on the area with your fingers), stiffness, loss of flexibility, bone spurs and inflammation. Treatment options involve a combination of non-surgical and surgical modalities (in severe cases). Treatment

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modalities include pain medications, physical therapy, cortisone injections, lubrication injections, knee osteotomy and joint replacement surgery. The ICD-10 codes for osteoarthritis (OA) – 

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M16 - Osteoarthritis of hip 

M16.0 - Bilateral primary osteoarthritis of hip

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M16.1 - Unilateral primary osteoarthritis of hip

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M16.2 - Bilateral osteoarthritis resulting from hip dysplasia

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M16.3 - Unilateral osteoarthritis resulting from hip dysplasia

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M16.4 - Bilateral post-traumatic osteoarthritis of hip

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M16.5 - Unilateral post-traumatic osteoarthritis of hip

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M16.6 - Other bilateral secondary osteoarthritis of hip

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M16.7 - Other unilateral secondary osteoarthritis of hip

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M16.9 - Osteoarthritis of hip, unspecified

M17 - Osteoarthritis of knee 

M17.0 - Bilateral primary osteoarthritis of knee

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M17.1 - Unilateral primary osteoarthritis of knee

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M17.2 - Bilateral post-traumatic osteoarthritis of knee

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M17.3 - Unilateral post-traumatic osteoarthritis of knee

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M17.4 - Other bilateral secondary osteoarthritis of knee

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M17.5 - Other unilateral secondary osteoarthritis of knee

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M17.9 - Osteoarthritis of knee, unspecified

M18 - Osteoarthritis of first carpometacarpal joint 

M18.0 - Bilateral primary osteoarthritis of first carpometacarpal joints

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M18.1 - Unilateral primary osteoarthritis of first carpometacarpal joint

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M18.2 - Bilateral post-traumatic osteoarthritis of first carpometacarpal joints

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M18.3 - Unilateral post-traumatic osteoarthritis of first carpometacarpal joint

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M18.4 - Other bilateral secondary osteoarthritis of first carpometacarpal joints

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M18.5 - Other unilateral secondary osteoarthritis of first carpometacarpal joint

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M18.9 - Osteoarthritis of first carpometacarpal joint, unspecified

M19 - Other and unspecified osteoarthritis 

M19.0 - Primary osteoarthritis of other joints

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M19.1 - Post-traumatic osteoarthritis of other joints

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M19.2 - Secondary osteoarthritis of other joints

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M19.9 - Osteoarthritis, unspecified site

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Osteoporosis - Osteoporosis is a bone disease that involves abnormal loss of bony tissue resulting in fragile or porous bones. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Reports from the International Osteoporosis Foundation estimates that 44 million women and men aged 50 years and above suffer from this condition or have low bone mass. The condition does not depict any specific symptoms in the early stages of bone loss. But, once your bones get weakened by osteoporosis, patients may experience symptoms like - back pain, (caused by a fractured or collapsed vertebra), loss of height over time, a stooped posture and breaking of bones (more easily than expected).

An ICD-10 code from M80- Series should be reported if the patient who visits physician’s office has a current pathological fracture during the time of encounter. 

M80 - Osteoporosis with current pathological fracture 

M80.0 - Age-related osteoporosis with current pathological fracture 

M80.00

-

Age-related

osteoporosis

with

current

pathological

fracture,

unspecified site 

M80.01 - Age-related osteoporosis with current pathological fracture, shoulder 

M80.011 - Age-related osteoporosis with current pathological fracture, right shoulder

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M80.012 - Age-related osteoporosis with current pathological fracture, left shoulder

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M80.019 - Age-related osteoporosis with current pathological fracture, unspecified shoulder

On the other hand, if the patient does not have a current pathological fracture, a code from M81-series should be selected (even if the patient had pathological fracture in the past).

The codes in this series include – 

M81 - Osteoporosis without current pathological fracture 

M81.0 - Age-related osteoporosis without current pathological fracture

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M81.6 - Localized osteoporosis [Lequesne]

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M81.8 - Other osteoporosis without current pathological fracture

Fractures – A common orthopedic problem faced by the elderly, a fracture is a break, usually in a bone. As people grow older, their bone mineral density decreases. Decreased mineral levels translate to weaker, more brittle bones. The condition is typically more problematic in post-menopausal women. Fractures commonly occur due to falls, sports

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injuries or motor vehicle accidents. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can also cause stress fractures, which leads to very small cracks in the bone. Common symptoms include intense pain, deformity (the limb looks out of place), swelling, bruising, or tenderness, numbness and tingling and problems moving a limb. Strength training exercises are a perfect way to increase bone strength, which can reduce the likelihood of fracturing a bone. Related ICD-10 codes include 

S52 - Fracture of forearm 

S52.0 - Fracture of upper end of ulna

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S52.1- Fracture of upper end of radius

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S52.2- Fracture of shaft of ulna

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S52.3- Fracture of shaft of radius

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S52.5- Fracture of lower end of radius

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S52.6- Fracture of lower end of ulna

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S52.9- Unspecified fracture of forearm

Dislocations – A dislocation occurs when a bone slips out of a joint. The condition refers to an injury to a joint (a place where two or more bones come together) in which the ends of your bones are forced to slip from their normal position. The painful injury temporarily deforms and immobilizes your joint. A dislocated joint can be visibly deformed or out of place, intensely painful, swollen or discolored and immovable. The condition most commonly occurs in the shoulders and fingers. Other sites include elbows, knees and hips. Dislocations can occur in contact sports, such as football and hockey, and in sports in which falls are common, such as downhill skiing, gymnastics and volleyball. Treatment of the dislocation depends on the site and the severity of your injury and may generally comprise of – reduction (gentle maneuvers), immobilization and rehabilitation. Surgery may be considered in extreme cases if the orthopedists cannot move the dislocated bones to their correct positions or if the nearby blood vessels, nerves or ligaments have been damaged. The ICD10 codes for dislocations are – 

M24.4 - Recurrent dislocation of joint 

M24.40 - Recurrent dislocation, unspecified joint

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M24.41 - Recurrent dislocation, shoulder

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M24.42 - Recurrent dislocation, elbow

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M24.43 - Recurrent dislocation, wrist

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M24.44 - Recurrent dislocation, hand and finger(s)

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M24.45 - Recurrent dislocation, hip

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M24.46 - Recurrent dislocation, knee

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M24.47 - Recurrent dislocation, ankle, foot and toes

Chronic musculoskeletal disorders and injuries can have a profound impact on the health and quality of life of the elderly population. Ignoring an injury can make it worse or carrying on as normal can even lead to additional injuries. According to reports, there are nearly 45 million people above the age of 65 in the United States, and this figure is expected to increase to 98 million by the end of 2060. This rapid increase in the aging population and biological changes to older adults’ bodies signify the fact that orthopedic injuries will also become common. Taking adequate preventive measures early can help reduce the occurrence and intensity of injuries in the long run.

Knowing the highly specific ICD-10 codes related to documenting orthopedic problems is critical for healthcare providers. The support of an experienced medical billing and coding company can be very helpful when it comes to ensuring timely and accurate claims submission for optimal reimbursement.

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