ICD-10 Coding for Arthritis Not Otherwise Specified(M19.90, M06.9)
Complete ICD-10-CM coding and documentation guide for Arthritis Not Otherwise Specified. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Arthritis Not Otherwise Specified
M00-M25Primary Range
Arthropathies
This range includes all types of arthritis, including unspecified forms.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M19.90 | Unspecified osteoarthritis, unspecified site | Use when osteoarthritis is diagnosed but the specific site is not documented. |
|
| M06.9 | Rheumatoid arthritis, unspecified | Use when rheumatoid arthritis is suspected but not confirmed by serology. |
|
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 not otherwise specified
Essential facts and insights about Arthritis Not Otherwise Specified
Primary ICD-10-CM Codes for arthritis not otherwise specified
Decision Criteria
clinical Criteria
- Imaging confirms degenerative changes without inflammation.
documentation Criteria
- Documentation lacks specific site or type of osteoarthritis.
Applicable To
- Degenerative joint disease
- Osteoarthritis NOS
Excludes
- Inflammatory arthritis
- Rheumatoid arthritis
Clinical Validation Requirements
- Imaging showing osteophytes or joint space narrowing
- Normal inflammatory markers
- Absence of synovitis on exam
Code-Specific Risks
- Coding without imaging confirmation
- Use with elevated ESR/CRP
Coding Notes
- Ensure documentation specifies degenerative changes without inflammatory markers.
M06.9 - Rheumatoid arthritis, unspecified
Use when rheumatoid arthritis is suspected but not confirmed by serology.
Applicable To
- Inflammatory arthritis
- Rheumatoid arthritis NOS
Excludes
- Osteoarthritis
- Psoriatic arthritis
Clinical Validation Requirements
- Rheumatoid factor/CCP results
- Documentation of symmetrical involvement
- Morning stiffness duration
Coding Notes
Ensure documentation includes serological testing results.
Differential 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 Not Otherwise Specified to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.90.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or audits.
Mitigation Strategy
Use detailed templates, Regular training on documentation standards
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Query provider to clarify if arthritis is inflammatory or degenerative.
Impact
High risk of audits when using unspecified codes without supporting documentation.
Mitigation Strategy
Ensure all documentation is complete and specific.
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 Not Otherwise Specified, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Arthritis Not Otherwise Specified
Use these documentation templates to ensure complete and accurate documentation for Arthritis Not Otherwise Specified. These templates include all required elements for proper coding and billing.
Rheumatology Progress Note
Specialty: RheumatologyRequired Elements
- Joint Examination
- Diagnostic Correlation
- Impression
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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