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December 19, 2005

Coding for Arthritis
For The Record
Vol. 17 No. 26 P. 31

Arthritis is a general term which literally means joint inflammation and includes a group of more than 100 diseases. The following are the more common types of arthritis:

Osteoarthritis
Also documented as degenerative joint disease, osteoarthritis is characterized by the breakdown of joint cartilage and may affect any joint in the body. There is no cure for osteoarthritis, but medications can relieve the following possible symptoms:

• pain associated with use or inactivity;

• discomfort in joints due to change in weather;

• swelling and stiffness;

• bony lumps in joints; and

• loss of joint flexibility.

Osteoarthritis of all joints—except the spine—is classified to ICD-9-CM category 715. The fourth digit subcategory classifies the type of osteoarthritis such as generalized or localized and primary or secondary. If a patient suffers from osteoarthritis of only one site, but the documentation does not specify if it is primary or secondary, then it is assigned to subcategory 715.3, localized osteoarthrosis, not specified whether primary or secondary. (AHA Coding Clinic for ICD-9-CM, fourth quarter 2003, page 118 and second quarter 1995, page 5.)

In addition, an instructional note located under category 715 states, “Localized, in the subcategories below, includes bilateral involvement of the same site.” Therefore, bilateral osteoarthritis of a site is still considered to be localized. If the patient has osteoarthritis of more than one site, but it is not documented as generalized, assign a code from subcategory 715.8, osteoarthrosis involving, or with mention of, more than one site, but not specified as generalized. The fifth digit for category 715 identifies the location affected by osteoarthritis. Osteoarthritis of the spine is classified to category 721.

Osteoarthritis may be treated with medications to relieve the pain and inflammation. If the joint can no longer function properly, the patient may require a joint replacement. Total hip replacement is classified to code 81.51 and partial hip replacement to code 81.52. Code 81.54 identifies both partial and total knee replacement. Effective October 1, 2005, new codes were created to identify revision of hip and knee components. According to Coding Clinic, “Any time the joint is replaced or revised after the initial replacement would be considered a revision.” (AHA Coding Clinic for ICD-9-CM, second quarter 1996, page 13.) The new codes for the hip replacement components include the following:

• 00.70, revision of hip replacement, both acetabular and femoral components;

• 00.71, revision of hip replacement, acetabular component;

• 00.72, revision of hip replacement, femoral component; and

• 00.73, revision of hip replacement, acetabular liner and/or femoral head only.

The new codes for the knee replacement components include the following:

• 00.80, revision of knee replacement, total (all components);

• 00.81, revision of knee replacement, tibial component;

• 00.82, revision of knee replacement, femoral component;

• 00.83, revision of knee replacement, patellar component; and

• 00.84, revision of total knee replacement, tibial insert (liner).

An instructional note under subcategory 00.8 states, “Report up to two components using 00.81 to 00.83 to describe revision of knee replacements. If all three components are revised, report 00.80.” In other words, if the tibial and femoral components are revised, assign both codes 00.81 and 00.82.

Rheumatoid Arthritis
Rheumatoid arthritis (714.0), the most debilitating of all forms of arthritis, is an inflammatory condition which causes the body’s immune system to attack the synovium.

The signs and symptoms include the following:

• pain and swelling in joints, especially the hands and feet;

• loss of motion in the affected joints;

• fatigue;

• fever; and

• deformity of joints.

Rheumatoid arthritis may be treated with the following medications:

• nonsteroidal anti-inflammatory drugs (NSAIDs) — aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Aleve);

• COX-2 inhibitors — celecoxib (Celebrex);

• corticosteroids — prednisone and methylprednisolone (Medrol);

• disease-modifying anti-rheumatic drugs (DMARDs) — hydroxychloroquine (Plaquenil), auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), and methotrexate (Rheumatrex);

• immunosuppressants — leflumomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune), and cyclophosphamide (Cytoxan);

• tumor necrosis factor (TNF) blockers — etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira);

• interleukin-1 receptor antagonist (IL-1Ra) — anakinra (Kineret); and

• antidepressants — amitriptyline, nortriptyline (Aventyl, Pamelor), and trazodone (Desyrel).

Gout
Gout is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in joints and is caused by accumulation of urate crystals. When gout is documented with no further specificity, code 274.9 is assigned. Code 274.0 is assigned when the gout is documented as due to arthritis or when gouty arthropathy is documented.

Septic Arthritis
Septic arthritis (711.0x) is an infection of the joint and is characterized by the following symptoms:

• joint pain;

• decreased range of motion of joint;

• skin redness, warmth and tenderness around affected joint;

• open skin sores and drainage; and

• fever and chills.

A fifth digit is required to identify the affected joint. Septic arthritis is treated with antibiotics for two to six weeks.

Coding and sequencing for arthritis are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Health Information Systems (800-367-2447), a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information.

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