Traumatic arthropathy (M12.5-) vs Post-traumatic osteoarthritis (M19.1-)
I've been working coding scenarios in preparation for my HSC-D exam. Under what conditions does one use traumatic arthropathy M12.5-)vs post-traumatic osteoarthritis (M19.1-)? For example, you will notice in the coding scenarios at the end of Ch 13 in the 2017 Home Health Coding Manual (p 1258 and p 1259) they use the M12.5 codes both times when the arthritis follows a fracture, followed by the sequelae code for the fracture. I looked for official guidance in the coding manual that distinguishes when to use M12.5 vs M19.1, but was unable to find any. Does anyone have any clarification on these codes and when to use one vs. using the other?
Thanks!
Thanks!
Comments
Traumatic arthropathy is due to an injury to the joint that caused bleeding, swelling and/or distension of the joint. The injury results in joint disease due to the formation of adhesions between the tissue covering the articular cartilage and fibrous ankylosis.
Post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, a vehicle accident, a fall, a military injury, or any other source of physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
So, the correct code will depend on the physician's documentation: M19.1- when the sequela of injury is stated as arthritis, and M12.5- for any other joint disease due to injury.
Susan Winokur, HCS-D, BCHH-C | Southwest Medical
Part of OptumCare
Senior Medical Coder, Home Health
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Susan.Winokur@optum.com
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