1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 11 Coding for Musculoskeletal System and Connective Tissue Diseases

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Musculoskeletal System and Connective Tissue Diseases Musculoskeletal system and connective tissue diseases are included in code section 710 to 739 of chapter 13, in the Disease Tabular of ICD-9-CM

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Musculoskeletal Disorders: Arthritic Disorders Osteoarthritis (OA) (715.0-9X) –Degenerative joint disease (DJD) –Primary (idiopathic) versus secondary (caused by injury or disease) Rheumatoid arthritis (714.0) –Autoimmune disorder Gouty arthritis (274.00 – 274.03) –Excessive uric acid levels

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Musculoskeletal Disorders: Joint Derangements Chronic disorder –Old injury –Code 717.0-9 Acute injury –Current injury –836.0-6X

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Musculoskeletal Disorders: Bone Fractures Pathologic fractures –Spontaneous fracture (non-traumatic) occurring from weakened bone state due to disease –Examples of diseases that may result in pathological fractures : osteoporosis, osteopenia, bone metastases Traumatic fractures –Due to injury/trauma –Example: football injury, motor vehicle collision, fall from ladder Stress fractures - Due to repetitive application of force/overuse - Example: running long distances

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Musculoskeletal Disorders: Inflammatory Conditions Osteomyelitis (730.XX) –Bone and bone marrow inflammation –Caused by bacterial infection Necrotizing fasciitis (728.26) –Infection of fibrous membrane that surrounds muscle Costochondritis (733.6) –Inflammation of the cartilage between the sternum and the ribs (usually resulting from over-strenous activity; although non-coronary, chest pain similar to CAD

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Musculoskeletal Disorders: Back and Spine Disorders Back pain NOS (724.5) Low back pain (724.2) Displacement of an intervertebral disk (i.e., slipped disk, ruptured disk, herniated nucleus pulposis [HNP]), and spinal stenosis –Surgical intervention Laminectomy (decompressive) (03.09) Laminectomy with diskectomy (code 80.51 for diskectomy only; laminectomy is considered an operative approach, and the code is omitted) Fusion procedure (81.0X) Spondylosis –Degeneration of intervertebral disks (DJD of spine)

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Connective Tissue Diseases Systemic lupus erythematosus (SLE) (710.0) –Autoimmune disorder that causes damage to connective tissues (collagen) and may affect many organs (i.e., “systemic” including joints, skin, heart, kidneys, lungs). Systemic sclerosis (scleroderma) (710.1) –A chronic progressive disease of the skin causing hardening and shrinking of connective tissue that may also affect internal organs (i.e., “systemic”) such as the esophagus, heart, lungs, and kidneys. The cause is unknown.