ICD-9-CM Official Guidelines for Coding and Reporting

Please refer to the companion Evolve website for the most current guidelines.

Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 6.

ICD-10-CM Official Guidelines for Coding and Reporting

Please refer to the companion Evolve website for the most current guidelines.

Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 7.

Guideline Differences between ICD-9-CM and ICD-10-CM

Because there are significant differences in the coding of musculoskeletal and connective tissue diseases in ICD-10-CM, there are guidelines that address these differences.

ICD-10-CM codes identify laterality with different code assignments for right versus left. The guidelines address the issue of acute traumatic injury versus a chronic/recurrent musculoskeletal condition. Any current acute injury is assigned a code from Chapter 19 in ICD-10-CM, Injury, Poisoning, and Certain Other Consequences of External Causes. Chronic/recurrent conditions are generally assigned codes from Chapter 13 in ICD-10-CM, Diseases of the Musculoskeletal System and Connective Tissue.

The seventh-character extension is a new concept in ICD-10-CM. These character extensions are used in this chapter to code pathologic fractures.

ICD-10-CM uses a combination code for osteoporosis with pathologic fracture, and guidelines address the coding of osteoporosis with or without pathologic fracture. In ICD-9-CM, these two conditions were coded separately.

Major Differences between ICD-9-CM and ICD-10-CM

Some of the differences have already been identified in the guidelines section. Other differences include:

Anatomy and Physiology

The musculoskeletal system is made up of muscles, bones, ligaments, tendons, cartilage, and the joints they form. The purposes of the musculoskeletal system are to provide a framework and to protect the internal organs. Bones also are important for hematopoiesis and for storing calcium and phosphate. Hematopoiesis is the development of blood cells that occurs in the bone marrow and lymphatic tissue of normal adults.

A good grasp of anatomy is essential in coding conditions of the musculoskeletal system. It is important to know that the femur is the long bone in the thigh area, and that the radius and the ulna are two bones in the forearm. Pictures are best for illustrating the locations of the skeletal structures (Figure 19-1) and muscles (Figure 19-2). It is particularly important to understand the terms used in the musculoskeletal chapter to describe the location of structures relative to the body as a whole or to other body structures (Figure 19-3). Anterior or ventral describes the front of the body or an organ. Posterior or dorsal relates to the back of the body or an organ. The terms medial and lateral describe the position of the body or an organ relative to the median sagittal plane that divides the body in half. Medial refers to a structure that is closer to the median plane than is another structure in the body. The eyes are medial to the ears. Lateral refers to a structure that is to the side of the body. The ears are lateral to the eyes. The terms superior (above) and inferior (below) describe the position of the body or an organ relative to the vertical axis of the body. The shoulders are superior to the hips, and the ankles are inferior to the knees. Other terms that may be used are cranial, which means toward the head, and caudal, which means toward the tail. Proximal (closer to the point of reference) and distal (farther from the point of reference) are often used to describe a location in the limbs. The shoulder is proximal to the elbow, and the wrist is distal to the elbow. Supine refers to lying on the back, face up. Prone is lying on the stomach, face down.

The joints are the means of joining two bones together; they assist with body movement. Ligaments are dense fibrous bands of connective tissue that provide stability for the joint. Ligaments can be injured by overstretching or tearing (sprain). Tendons are the connective tissue that attaches muscle to bone. Tendons are susceptible to strain injuries. The fascia is the tissue just below the skin that covers and separates the underlying layers of muscle.

Disease Conditions

Diseases of the Musculoskeletal System and Connective Tissue (710-739), Chapter 13 in your ICD-9-CM code book, is divided into the following categories:

Diseases of the Musculoskeletal System and Connective Tissue (M00-M99), Chapter 13 in the ICD-10-CM code book, are divided into the following categories:

One of the most important parts of this chapter in ICD-9-CM is the breakdown of the fifth-digit subclassifications that are used with categories 711-712, 715-716, 718-719, and 730; this information appears at the very beginning of the chapter (Figure 19-4) and is provided to assist in making the proper fifth-digit assignment. One may not remember whether the wrist fits into the subclassification of 3 for forearm, or 4 for hand. The appropriate fifth-digit subclassification for wrist joint is 3, forearm.

Exercise 19-1

Using Figure 19-4, assign the appropriate fifth digits to the following conditions.