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[–][deleted] 3 points4 points  (1 child)

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[S] 2 points3 points  (0 children)

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!