May 01, 2013 | | Comments 0
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Get to know ICD-10 codes for wrist and hand conditions

Penny comes in to see Dr. Morang for pain in her wrist. After performing a comprehensive exam and history, Dr. Morang documents the following ICD-9-CM codes:

  • 354.0, carpal tunnel
  • 715.04, osteoarthrosis, generalized, hand
  • 719.43, pain in forearm
  • 728.6, contracture of palmer fascia

How would we code Penny’s diagnoses in ICD-10-CM? Let’s start with her carpal tunnel. If we look up syndrome, carpal tunnel in the ICD-10-CM Alphabetic Index, it directs us to G56.0-. The dash tells us the code needs additional characters, so we absolutely must look in the Tabular Index.

You should never code from the Alphabetic Index alone, anyway. That’s one of the many things that won’t change after the transition to ICD-10-CM.

G56.0 gives us three choices:

  • G56.00, carpal tunnel syndrome, unspecified upper limb
  • G56.01, carpal tunnel syndrome, right upper limb
  • G56.02, carpal tunnel syndrome, left upper limb

We need to review Dr. Morang’s documentation to determine the laterality so we can assign the most detailed code. ICD-10-CM does include an unspecified option, but we want to avoid reporting unspecified if at all possible. That means if the physician didn’t document laterality, query!

Moving on to the osteoarthrosis, we find a note in the Alphabetic Index that tells us to see also Osteoarthritis.

Generalized osteoarthrosis of the hand doesn’t really give us much to go on to find the correct ICD-10-CM code. We need more information.

Does Penny suffer from bony bumps on the finger joint closest to the fingernail (Heberden’s nodes), which would lead us to ICD-10-CM code M15.1 (Heberden’s nodes [with arthropathy]).

Or does she have bony bumps on the middle joint of the finger (Bouchard’s nodes)? In that case, we would report M15.2 (Bouchard’s nodes [with arthropathy]).

Does Dr. Morang mean Penny suffers from osteoarthritis of the hand joint or the bones in her hand in general?

We also need to know if the osteoarthrosis is primary, secondary, or post-traumatic.

For the pain in Penny’s forearm, we again need laterality. Our choices are:

  • M79.631, pain in right forearm
  • M79.632, pain in left forearm
  • M79.639, pain in unspecified forearm

We also need to know if the pain is a separate problem or if it is a symptom of one of Penny’s other diagnoses. If it’s a symptom, we don’t code it separately (regardless of what Dr. Morang says).

Finally, we need to code the contracture of palmer fascia. You may be more familiar with the term Dupuytren’s contracture. Both lead us to the same ICD-10-CM code—M72.0 (palmar fascial fibromatosis [Dupuytren]).

Interestingly, M72.0 does not require laterality. We only have one code, which could be a problem if Penny develops the same condition in both hands.

So we’ll wish Penny well, but avoid shaking her hand.

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Michelle A. Leppert About the Author: Michelle A. Leppert, CPC, is a senior managing editor for JustCoding.com. JustCoding provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.

In addition, she writes and edits the HCPro publication, Briefings on Coding Compliance Strategies. Email her at mleppert@hcpro.com.

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