Documenting and Coding Avascular Necrosis – A Common Bone Condition

Documenting and Coding Avascular Necrosis – A Common Bone Condition

The article discusses a common orthopedic bone condition – avascular necrosis and its related ICD-10 codes.

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Avascular necrosis (AVN) is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis or ischemic bone necrosis, the condition can lead to tiny breaks in the bone and the bone's eventual collapse. Breakage or dislocation of joint can interrupt the blood flow to a specific part of bone.

Reduced blood flow to a bone can occur due to several causes like – bone or joint injury, fatty deposits in blood vessels, long-term use of high-dose steroid medications, excessive alcohol intake, and medical conditions such as sickle cell anemia and Gaucher's disease. Avascular necrosis or osteonecrosis can affect any person, but the condition is most common in people in the age group of 30-50 years. It is estimated that for about 25 percent of people with this condition, the cause of interrupted blood flow is unknown. If left untreated, osteonecrosis worsens over time leading to bone collapse or causes the bone to lose its smooth shape, potentially leading to severe arthritis. In addition, people with AVN may need joint replacement surgery. Orthopedics medical billing can be a challenging procedure. For correct clinical documentation of this bone condition, orthopedic surgeons and other specialists can rely on the services of a reliable medical billing company.

Typical Symptoms of AVN Generally, most people do not experience any specific symptoms in the early stages of AVN. However, as the condition worsens, the affected joint may get hurt if additional weight is put on it. The pain may develop gradually and can be either mild or severe.

Hip pain is typically the first symptom associated with the condition. This may involve a dull ache or throbbing pain in the groin or buttock area. As the disease progresses, it becomes more difficult to stand and put weight on the affected hip, and moving the hip joint becomes painful. Besides the hip, the areas likely to be affected are the shoulder, knee, hand and foot. However, some people develop avascular necrosis on both sides (bilaterally) — such as in both hips or in both knees. Other associated symptoms include –  Mild or severe pain in or around the affected joint  Groin pain that spreads down to the knee  Pain that occurs when putting weight on the hip or knee www.outsourcestrategies.com

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 Joint pain severe enough to limit movement Pain may increase in intensity due to tiny breaks in the bone (called micro fractures). These can cause the bone to collapse and ultimately cause the joint to break down and develop arthritis.

Diagnosing and Treating Avascular Necrosis Generally, AVN may take from several months to over a year to progress. It is important to diagnose the condition early, as some studies show that early treatment is associated with better outcomes.

Diagnosis of this bone cone condition may begin with a physical examination wherein the physician may press around the joints and check for tenderness.

Physicians may move the joints through a variety of positions to see if the patient’s range of motion has been reduced. In addition, they may also check for bone pain that is limited (localized) to a small area. Imaging tests such as X-ray, MRI scan, CT scan, bone scan and functional bone tests may also be recommended to help pinpoint the source of pain.

Treatment for AVN may depend on the patient’s age, the causes of AVN, number of bones damaged and how much damage has occurred. Early stage avascular necrosis may be managed with medications and other additional therapies. Physicians may recommend – non-steroidal anti-inflammatory drugs (like ibuprofen, naproxen sodium (Aleve), blood thinners, osteoporosis drugs, cholesterol-lowering drugs, physical therapy exercises, electrical stimulation and adequate body rest. However, if the bone condition gets worse and reaches a fairly advanced stage, physicians may recommend surgery. Surgical options include – core decompression, bone transplant (graft), vascularized fibula graft, bone reshaping (osteotomy), joint replacement and regenerative medicine treatment.

Orthopedists perform screening procedures and provide treatment for AVN, and these have to be documented accurately. Reputable medical billing and coding companies are a great support to these specialists when it comes to

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correct documentation. Here is a list of ICD-10 codes used for diagnosing AVN – M87 Osteonecrosis M87.0 Idiopathic aseptic necrosis of bone          

M87.00 Idiopathic aseptic necrosis of unspecified bone M87.01 Idiopathic aseptic necrosis of shoulder M87.02 Idiopathic aseptic necrosis of humerus M87.03 Idiopathic aseptic necrosis of radius, ulna and carpus M87.04 Idiopathic aseptic necrosis of hand and fingers M87.05 Idiopathic aseptic necrosis of pelvis and femur M87.06 Idiopathic aseptic necrosis of tibia and fibula M87.07 Idiopathic aseptic necrosis of ankle, foot and toes M87.08 Idiopathic aseptic necrosis of bone, other site M87.09 Idiopathic aseptic necrosis of bone, multiple sites

M87.1 Osteonecrosis due to drugs  M87.10 Osteonecrosis due to drugs, unspecified bone  M87.11 Osteonecrosis due to drugs, shoulder  M87.12 Osteonecrosis due to drugs, humerus  M87.13 Osteonecrosis due to drugs of radius, ulna and carpus  M87.14 Osteonecrosis due to drugs, hand and fingers  M87.15 Osteonecrosis due to drugs, pelvis and femur  M87.16 Osteonecrosis due to drugs, tibia and fibula  M87.17 Osteonecrosis due to drugs, ankle, foot and toes  M87.18 Osteonecrosis due to drugs, other site  M87.19 Osteonecrosis due to drugs, multiple sites M87.2 Osteonecrosis due to previous trauma  M87.20 Osteonecrosis due to previous trauma, unspecified bone  M87.21 Osteonecrosis due to previous trauma, shoulder  M87.22 Osteonecrosis due to previous trauma, humerus

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 M87.23 Osteonecrosis due to previous trauma of radius, ulna and carpus  M87.24 Osteonecrosis due to previous trauma, hand and fingers  M87.25 Osteonecrosis due to previous trauma, pelvis and femur  M87.26 Osteonecrosis due to previous trauma, tibia and fibula  M87.27 Osteonecrosis due to previous trauma, ankle, foot and toes  M87.28 Osteonecrosis due to previous trauma, other site  M87.29 Osteonecrosis due to previous trauma, multiple sites M87.3 Other secondary osteonecrosis          

M87.30 Other secondary osteonecrosis, unspecified bone M87.31 Other secondary osteonecrosis, shoulder M87.32 Other secondary osteonecrosis, humerus M87.33 Other secondary osteonecrosis of radius, ulna and carpus M87.34 Other secondary osteonecrosis, hand and fingers M87.35 Other secondary osteonecrosis, pelvis and femur M87.36 Other secondary osteonecrosis, tibia and fibula M87.37 Other secondary osteonecrosis, ankle and foot M87.38 Other secondary osteonecrosis, other site M87.39 Other secondary osteonecrosis, multiple sites

M87.8 Other osteonecrosis          

M87.80 Other osteonecrosis, unspecified bone M87.81 Other osteonecrosis, shoulder M87.82 Other osteonecrosis, humerus M87.83 Other osteonecrosis of radius, ulna and carpus M87.84 Other osteonecrosis, hand and fingers M87.85 Other osteonecrosis, pelvis and femur M87.86 Other osteonecrosis, tibia and fibula M87.87 Other osteonecrosis, ankle, foot and toes M87.88 Other osteonecrosis, other site M87.89 Other osteonecrosis, multiple sites

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M87.9 Osteonecrosis, unspecified Generally, most severe cases of AVN will eventually need surgery. Most people can lead an active life by undergoing the right treatment at the right time.

However, it is important for patients to limit their activities and follow the physician’s instructions to protect the joint correctly. Prevention strategies include –quitting the habit of smoking, limiting the intake of alcohol, monitoring steroid use, and keeping cholesterol levels normal.

Billing and coding tasks for documenting different bone conditions can be complex. However, with the support of a reliable medical coding service provider, these tasks can be done efficiently. Billers and coders in medical billing companies can help with correct reporting of symptoms and other details, which in turn will help in accurate claim submission and timely reimbursement.

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