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April 12, 2010

Coding for Temporomandibular Joint Disorders
For The Record
Vol. 22 No. 7 P. 27

Temporomandibular joint (TMJ) disorders are medical problems related to the jaw joint. The TMJ is located on each side of the head in front of the ears where the lower jawbone (mandible) meets the skull (temporal bone). TMJ disorders occur due to unbalanced activity, spasm, and overuse of the jaw muscles.

TMJ disorders are classified to ICD-9-CM subcategory 524.6. A fifth digit is required as follows:

• 524.60, Temporomandibular joint disorders, unspecified (includes temporomandibular joint-pain-dysfunction syndrome);

• 524.61, Adhesions and ankylosis (bony or fibrous) of temporomandibular joint;

• 524.62, Arthralgia of temporomandibular joint;

• 524.63, Articular disc disorder (reducing or nonreducing);

• 524.64, Temporomandibular joint sounds on opening and/or closing the jaw; and

• 524.69, Other specified temporomandibular joint disorders.

TMJ disorders may also be documented as Costen’s syndrome or myofacial pain dysfunction. Costen’s syndrome is indexed to code 524.60, but there is no specific code assignment for myofacial pain dysfunction. The physician may need to be queried for clarification of specific diagnosis if the patient exhibits some signs and symptoms common to TMJ disorders. Crepitus of the jaw is also classified to code 524.60.

Common causes of TMJ disorders involve trauma, disease, aging, and habits and specifically include disc erosion, malaligned joint, cartilage damaged by arthritis (osteoarthritis or rheumatoid arthritis), joint damage due to impact, fatigued muscles that stabilize the joint, teeth grinding (bruxism), malocclusion, and stress.

Signs and Symptoms
Common signs and symptoms of TMJ disorders include jaw pain or tenderness; limited jaw movement; swelling on the affected side; ear or facial pain; difficulty chewing or discomfort while chewing; an uncomfortable or uneven bite; locking of the joint that makes it difficult to open or close the mouth; sounds such as clicking, grating, grinding, crunching, or popping; headache; dizziness; a feeling of fullness in the ear; and tinnitus.

TMJ disorders may be diagnosed by a thorough history and physical examination, which may include a dental evaluation. The physician will check jaw movement, listen for sounds, and check the patient’s bite. The physician may also order x-rays, including dental x-rays, and CT or MRI scans.

In some cases of TMJ disorder, symptoms may disappear without treatment. In other cases, the following medications may be used to help relieve pain: nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, tricyclic antidepressants such as amitriptyline or nortriptyline, muscle relaxants such as carisoprodol or diazepam, corticosteroids, or botulism toxin (Botox).

Patients with TMJ disorders may also wear a bite guard if they grind their teeth while sleeping. In addition, jaw rest, heat and ice therapy, physical therapy, and/or stress management may be ordered.

Surgery may be necessary in severe cases of TMJ disorders to correct dental problems or abnormal bites and to balance biting surfaces. Surgery may also tighten ligaments or restructure the joint.

Coding and sequencing for TMJ disorders are dependent on 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 Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.