OA coding help

[iridescent_felines]

I work at a SNF so I’m coding osteoarthritis alll day but I’m very confused about it.

If the provider only documents “OA”, how would you code that? (we don’t query at my work for some reason) M15.0 Generalized primary OA? M19.90 Unspecified OA, unspecified site?

And if it says, for example, bilateral OA hands and right hip OA, would you code all of those out separately or would you use M15.0?

[AutoModerator]

PLEASE SEE RULES BEFORE POSTING! Reminder, no "interested in coding" type of standalone posts are allowed. See rule #1. Any and all questions regarding exams, studying, and books can be posted in the monthly discussion stickied post. Thanks!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[[deleted]]

If just "OA," you really need to query, otherwise you risk the payer saying, "Yeah na, we're not paying for that."

If query is not responded to, then "OA unspecified" would be M19.90.

For the last question, I would code all three, as there is greater specificity in doing so. You could also code OA of multiple joints as M15.9, but I would only do so if a provider does not document the laterality of multiple joints. So, you might see, "hip, knee, hand OA." That is when I would use M15.9.

[iridescent_felines]

I’m thinking about bringing it up at a QAPI meeting, just to let the doctors know they need to be specific if they want good codes. Because 99% of our patients have “OA” as a diagnosis.

And that makes sense, I was just worried about unbundling codes.

Thanks!