1. Musculoskeletal System
ICD-10-CM codes M00-M99
ICD-10-CM Guidelines for Coding & Reporting, Section I.C.13
© Kathleen Peterson, MS, RHIA, CCS 1

2. Symptoms & signs involving musculoskeletal system
R25 Abnormal involuntary movements
Cramp and spasm
R26 Abnormalities of gait and mobility
R27 Other lack of coordination
R29.6 Repeated falls
Z91.81 History of falling, At risk for falling
R Loss of height
R Ocular torticollis
© Kathleen Peterson, MS, RHIA, CCS

3. Musculoskeletal System & Connective Tissue: Features in ICD-10-CM
Official Coding Guidelines, I.C.13.a-d
Conditions coded to this chapter include
M1a Chronic Gout
M 10 Gout
M30 Polyarteritis nodosa
M26 Dentofacial anomalies, including malocclusion
M27 Diseases of jaw
M84.3- Stress fractures
M84.4- through M84.6- Pathological fractures
Bone, joint or muscle conditions that are recurrent or resulting from a healed injury
© Kathleen Peterson, MS, RHIA, CCS

4. ICD-10-CM Official Guidelines
I.C.13.a. Site and laterality
Site represents bone, joint or muscle involved
Some conditions may have a code for “multiple sites”
M10.09 Idiopathic gout, multiple sites
If category does not have “multiple sites” code, then assign codes to indicate different sites
M Recurrent dislocation of joint
Bone vs. joint: Although bone affected may be at the joint, the site designation will be the bone.
M Idiopathic aseptic necrosis of radius, ulna, and carpus
© Kathleen Peterson, MS, RHIA, CCS

5. ICD-10-CM Official Guidelines
I.C.13.b. Acute traumatic vs. chronic or recurrent musculoskeletal condition
Any current, acute injury is coded to Chapter 19, Injury
S83.014A Lateral dislocation of right patella, initial episode
Bone, joint or muscle conditions that result from healed injury or are recurrent are usually found in Chapter 13, Musculoskeletal system
M Recurrent incomplete dislocation of right knee
If documentation is unclear whether acute vs. chronic or recurrent condition, query the provider.
© Kathleen Peterson, MS, RHIA, CCS

6. Derangement / Joint replacement
Joint Derangement
Recurrent – see Derangement, joint, recurrent
Due to current injury – see Derangement, joint, current injury and Derangement, joint
Joint replacement
Assign code for disease process resulting in joint replacement
Assign Z96.6- for orthopedic joint replacement on subsequent admissions
© Kathleen Peterson, MS, RHIA, CCS

7. Pathological fractures
ICD-10-CM coding guideline I.C.13.c
Bone structure is weakened due to disease process
Osteoporosis, osteomalacia, osteomyelitis, or neoplasm
Review physician documentation
Trauma fracture are coded to Injuries
Pathological fracture  M80, M84.4-, M84.5-, M84.6-
7th characters are required to show initial, subsequent or sequela
Stress fracture  repetitive force  see M84.3-
Use additional external cause code(s) to identify cause of stress fracture
Example: Y93.01, Activity walking, marching and hiking
© Kathleen Peterson, MS, RHIA, CCS 7

8. Stress Fracture Identify sites: pelvis, extremities, vertebrae
Stress fractures of vertebrae are termed “fatigue fractures”.
Identify episode of care with 7th character
Initial, subsequent, sequela
M84.311A Stress fracture, right shoulder, initial episode
M48.42xB Fatigue fracture of vertebra, cervical region, subsequent encounter for routine healing
© Kathleen Peterson, MS, RHIA, CCS

9. Pathological or Stress Fractures (M84.3 – M84.6): Seventh Characters
Initial encounter for fracture
Active treatment: surgical treatment, ED encounter, evaluation & treatment by new MD D
Subsequent encounter for fracture with routine healing
Code use for fracture aftercare - change or remove cast, remove external or internal fixation device, medication adjustment, follow-up visits following fracture treatment) G
Subsequent encounter for fracture with delayed healing K
Subsequent encounter for fracture with nonunion P
Subsequent encounter for fracture with malunion S
Sequela
© Kathleen Peterson, MS, RHIA, CCS

10. Definitions in ICD-10-CM
M66 Spontaneous rupture of synovium and tendon
NOTE A spontaneous rupture is one that occurs when a normal force is applied to tissues that are inferred to have less than normal strength.
M80 Osteoporosis with current pathological fracture
NOTE Fragility fracture is defined as a fracture sustained with trauma no more than a fall from a standing height or less that occurs under circumstances that would not cause a fracture in a normal healthy bone.
© Kathleen Peterson, MS, RHIA, CCS

11. Osteoporosis ICD-10-CM coding guideline I.C.13.d.
M81.- Osteoporosis without current pathological fracture
Assign code even if patient has had fracture in past
Z87.310, Personal hx of (healed) osteoporosis fracture, is also assigned with M81.-
M80.- Osteoporosis with current pathological fracture
Assign code for patients with current pathological fracture at time of encounter
Assign code to identify fracture site
Use for patients with osteoporosis who suffer a fracture, even if it was a minor fall or trauma, that would not usually break a normal, healthy bone.
© Kathleen Peterson, MS, RHIA, CCS

12. Scoliosis (M41.-) Includes kyphoscoliosis Types
Idiopathic
Infantile (birth through age 4)
Juvenile (ages 5 through 10)
Adolescent (ages 11 through 17)
Secondary
Neuromuscular or other
Thoracogenic
Other form
Unspecified
Identify site: cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral, sacral/sacrococcygeal, unspecified
© Kathleen Peterson, MS, RHIA, CCS

13. Let’s Practice! Assign ICD-10-CM codes for:
Cervical spondylosis, C5-6, C6-7
Deformity of left ring finger, due to old flexor tendon laceration
Right hallux valgus
© Kathleen Peterson, MS, RHIA, CCS