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M19.90
ICD-10-CM
Osteoarthritis

Find information on osteoarthritis diagnosis, including clinical documentation tips, medical coding (ICD-10-CM codes M15-M19, SNOMED CT), healthcare guidelines, and best practices for accurate osteoarthritis documentation. Learn about common osteoarthritis symptoms, diagnostic criteria, and relevant medical terminology for effective communication in healthcare settings. This resource provides support for accurate and efficient osteoarthritis coding and documentation.

Also known as

Degenerative Joint Disease
Wear-and-Tear Arthritis
oa

Diagnosis Snapshot

Key Facts
  • Definition : Degenerative joint disease causing cartilage breakdown, leading to pain and stiffness.
  • Clinical Signs : Joint pain, stiffness, swelling, creaking, limited range of motion, and bone spurs.
  • Common Settings : Hips, knees, hands, spine; managed in primary care, orthopedics, and rheumatology.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M19.90 Coding
M15-M19

Osteoarthritis

Degenerative joint disease characterized by cartilage loss.

M00-M25

Arthopathies

Disorders affecting joints including inflammatory and non-inflammatory types.

M40-M54

Dorsalgia and low back pain

Pain and other symptoms related to the back, often associated with osteoarthritis.

M20-M25

Other joint disorders

Joint derangements and other specific joint conditions excluding osteoarthritis.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the osteoarthritis primary?

  • Yes

    Site of primary OA?

  • No

    Is it post-traumatic?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Osteoarthritis
Rheumatoid Arthritis
Gout

Documentation Best Practices

Documentation Checklist
  • Osteoarthritis diagnosis documentation checklist
  • ICD-10-CM code M15-M19: Document laterality (right, left, bilateral)
  • Document symptom onset, duration, and characteristics (e.g., pain, stiffness)
  • Document physical exam findings: joint tenderness, crepitus, range of motion
  • Radiographic evidence: Document findings supporting OA diagnosis (e.g., joint space narrowing)

Coding and Audit Risks

Common Risks
  • Laterality Coding Errors

    Missing or incorrect laterality (right, left, bilateral) for osteoarthritis can lead to claim denials and inaccurate reporting.

  • Specificity of Site

    Coding osteoarthritis requires specific joint documentation. Unspecified joint codes can cause claim rejections and affect quality metrics.

  • Primary vs. Secondary OA

    Distinguishing between primary and secondary osteoarthritis is crucial for accurate coding, impacting reimbursement and data analysis.

Mitigation Tips

Best Practices
  • Code OA precisely using ICD-10-CM codes M15-M19 for accurate reimbursement.
  • Document OA severity, affected joints, and functional limitations for improved CDI.
  • Ensure medical necessity for OA treatments aligns with payer guidelines for compliance.
  • Use standardized terminology for OA diagnoses and treatments to enhance data interoperability.
  • Regularly review and update OA documentation practices to reflect current clinical guidelines.

Clinical Decision Support

Checklist
  • Verify age 40 and older ICD10 M1519
  • Confirm joint pain and stiffness SNOMED CT 28737005
  • Check for crepitus on exam SNOMED CT 233511006
  • Exclude inflammatory arthritis ICD10 M05M08

Reimbursement and Quality Metrics

Impact Summary
  • Osteoarthritis reimbursement hinges on accurate ICD-10 (M15-M19) and CPT (e.g., 20610, 27130) coding, impacting claim denials and revenue cycle.
  • Quality metrics like pain management (e.g., NQF #0421) and functional improvement directly affect value-based reimbursement for osteoarthritis.
  • Proper documentation of osteoarthritis severity and treatment plans using clinical quality measures (CQMs) influences pay-for-performance incentives.
  • Timely coding and billing for osteoarthritis reduces days in A/R and improves hospital financial reporting accuracy.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code primary OA site (M15-M19)
  • Laterality: specify left/right/bilateral
  • Document symptom severity for 715.XX
  • Add 715.9X for unspecified OA
  • Confirm OA diagnosis, not just pain

Documentation Templates

Patient presents with complaints consistent with osteoarthritis (OA), characterized by joint pain, stiffness, and reduced range of motion.  The patient reports [duration of symptoms] of [specific joint location] pain, described as [character of pain: e.g., aching, sharp, throbbing].  Symptoms are [aggravating factors: e.g., worsened by activity, relieved by rest] and associated with [associated symptoms: e.g., crepitus, swelling, morning stiffness lasting [duration]].  Physical examination reveals [objective findings: e.g., tenderness to palpation, bony enlargement, limited range of motion in the affected joint, crepitus on movement].  Radiographic imaging of the [affected joint] demonstrates [radiographic findings: e.g., joint space narrowing, osteophytes, subchondral sclerosis].  These findings support a diagnosis of osteoarthritis.  Differential diagnoses considered include rheumatoid arthritis, gout, and pseudogout.  Based on the clinical presentation, imaging results, and patient history, the diagnosis of osteoarthritis is most likely.  The patient was educated on osteoarthritis management, including non-pharmacological interventions such as weight management, exercise, and physical therapy.  Pharmacological management options, including acetaminophen, NSAIDs, and topical analgesics, were discussed.  The patient was also advised on joint protection strategies and the potential benefits of assistive devices.  Follow-up was scheduled to monitor symptom progression and adjust the treatment plan as needed.  ICD-10 code M19.9 (Osteoarthritis, unspecified site) or more specific site code if applicable, will be used for billing and coding purposes.