Hi all, Hoping someone can help me with this. Thanks very much in advance. I had put this question out previously and thought I would put this out there again. Thanks for taking the time if you have any information. I think I didn't ask the question well initially. Show My question is, Can (Is it appropriate/standard of practice) a physician document 'pathologic fracture due to Osteoporosis'...... when there is NO definitive diagnosis of Osteoporosis prior to the fracture. There has never been a Dexascan to confirm the diagnosis. Example: Pt 54 has ground level fall and fractures hip. My orthopedic physician assistant felt that based on the 'Own the bone' etc literature that you could presume osteoporosis based on mechanism of injury....without any other definitive diagnostic test to confirm osteoporosis. The ortho surgeons however ....aren't sure that you can and aren't comfortable doing that. Thoughts? Any literature to support either side out there? Would it be appropriate without a confirmed diagnosis....and just based on the mechanism being GLF in pt >50 yrs old to state Pathological fracture due to possible Osteoporosis? If so, does anyone have any literature to support this? My physicians are wanting to see some literature before they would begin this.. I do understand from below which was sent as a response (thank you!), that if the osteoporosis was previously diagnosed that a link would be assumed with icd10. But the situations I am asking about is when there is NO prior confirmed diagnosis of osteoporosis. Thanks very much. Debbie Sent: Wednesday, November 04, 2015 1:10 PM Hi Deborah, Just wanted to share this... In ICD-10 Pathologic is now an assumed link, http://www.hcpro.com/HIM-276556-3288/Variations-in-ICD10-documentation-requirements-and-coding-guidance-highlight-need-for-Coding-Clinic-advice.html Guidance varies regarding cause-and-effect relationship The 2012 ICD-10-CM Official Guidelines for Coding and Reporting contains advice regarding the proper application of diagnosis codes from specific code categories. One example is how to correctly code a case in which the patient has both osteoporosis and a current pathological fracture. Currently, there is not an "assumed" cause-effect relationship in ICD-9-CM between an acute (i.e., new) fracture and osteoporosis. In other words, the terms "fracture" and "osteoporosis" documented on the same record do not equate to a diagnosis of "pathological fracture." A physician must clearly document this cause-effect relationship with terms such as "osteoporotic fracture", "fracture due to/associated with osteoporosis", or similar language. Without this link, the CDI specialist or coder must query the physician. In ICD-10-CM, however, this cause-effect relationship is assumed, supported by the following guidance from the ICD-10-CM Official Guidelines for Coding and Reporting (I.C.13.d.2): Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone. This guidance clearly directs the coder to assign the code for "pathological fracture," supporting an assumed cause-effect relationship between "fracture" and "osteoporosis." This represents the type of advice that is based on Coding Clinic advice over the years, and it is certain that coders and documentation specialists will welcome this explicit direction from the AHA because it averts the need for a provider query. Hope that helps! From: White, Deborah My orthopedic physicians don't feel comfortable stating 'pathologic fracture due to osteoporosis' if they don't have a dexascan or other definitive diagnosis for the osteoporosis. They are open to changing if I can give them some literature that it is standard of practice to do this. They are aware of: Own the Bone/American Osteopathic Association (AOA)/National Osteoporosis Association (NOF) state to start Vitamin D and Ca in patients ICD-Code M81.0 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Age-Related Osteoporosis without Current Pathological Fracture. Its corresponding ICD-9 code is 733. Billable: Yes ICD-9 Code Transition: 733 Code M81.0 is the diagnosis code used for Age-Related Osteoporosis without Current Pathological Fracture. A disorder characterized by Loss of bone mass and strength due to nutritional, metabolic, or other factors, usually resulting in deformity or fracture; a major public health problem of the elderly, especially women. Other Synonyms Include:
General ICD-10 InformationICD (International Statistical Classification of Diseases and Related Health problems) is now on its 10th revision. ICD-10 codes are the byproduct of that revision. This medical classification list is generated by the World Health Organization (WHO), and is used to help healthcare providers identify and code health conditions. ICD-10 is required for use by physicians and healthcare providers under the Health Insurance Portability & Accountability Act (HIPAA) and will replace all ICD-9 code sets. Many more new diagnoses can be tracked using ICD-10 than with ICD-9. Some expanded code sets, like ICD-10-CM, have over 70,000 codes.  What does unspecified pathological fracture mean?A break is called a pathologic fracture when force or impact didn't cause the break to happen. Instead, an underlying disease leaves your bones weak and brittle. You may move wrong or shift your body weight in a way that puts pressure on weak bones. For most people, it takes a significant force to break your bones.
What is osteoporosis with current pathological fracture?A pathologic bone fracture due to osteoporosis. It is generally caused by a fall from a standing height or lower and usually involves the spine, hip, or wrist. Breaks in bones resulting from low bone mass and microarchitectural deterioration characteristic of osteoporosis.
What is the ICDICD-9-CM and ICD-10-CM Codes. What is the ICDICD-Code M81. 0 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Age-Related Osteoporosis without Current Pathological Fracture. Its corresponding ICD-9 code is 733.
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Osteoporosis unspecified pathological fracture presence icd 10
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