ICD-10 Coding for Arthritis of the Left Hip(M16.12, M13.852)
Complete ICD-10-CM coding and documentation guide for Arthritis of the Left Hip. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Arthritis of the Left Hip
M16-M19Primary Range
Arthritis and osteoarthritis
This range includes codes for different types of arthritis affecting various joints, including the hip.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M16.12 | Unilateral primary osteoarthritis, left hip | Use when primary osteoarthritis is confirmed by imaging and clinical evaluation. |
|
| M13.852 | Other specified arthritis, left hip | Use when arthritis is specified but not osteoarthritis. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for arthritis left hip
Essential facts and insights about Arthritis of the Left Hip
Primary ICD-10-CM Codes for arthritis left hip
Decision Criteria
clinical Criteria
- X-ray evidence of osteophytes and joint space narrowing
documentation Criteria
- Explicit mention of 'primary osteoarthritis'
Applicable To
- Primary osteoarthritis of the left hip
Clinical Validation Requirements
- X-ray showing joint space narrowing
- Physical exam with limited range of motion
Code-Specific Risks
- Ensure documentation specifies 'primary' to avoid misclassification.
Coding Notes
- Ensure laterality is documented as 'left'.
M13.852 - Other specified arthritis, left hip
Use when arthritis is specified but not osteoarthritis.
Applicable To
- Non-osteoarthritis inflammatory arthritis
Excludes
- Osteoarthritis (M16.0-M16.9)
Clinical Validation Requirements
- Negative radiographic features for osteoarthritis
- Specific type of arthritis documented
Coding Notes
Ensure specific type of arthritis is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in left hip
M25.552Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Arthritis of the Left Hip to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M16.12.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Increases audit risk., Financial: Potential for denied claims.
Mitigation Strategy
Use specific terminology in documentation, Verify imaging findings
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Ensure detailed documentation to support specific code selection.
Impact
Using unspecified codes increases audit risk.
Mitigation Strategy
Ensure detailed documentation and use specific codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Arthritis of the Left Hip, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Arthritis of the Left Hip
Use these documentation templates to ensure complete and accurate documentation for Arthritis of the Left Hip. These templates include all required elements for proper coding and billing.
Primary osteoarthritis diagnosis
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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