How to Document and Code Osteoarthritis, a Degenerative Disease

One of the most common chronic joint conditions, osteoarthritis (OA) causes pain, swelling, stiffness and difficulty moving the joint. Also called degenerative joint disease (wear and tear arthritis), the condition occurs when the protective cartilage at the end of the joint breaks down and causes the bones to rub against each other. Although OA can damage any joint, the condition primarily affects the knees, and can also affect the fingers, thumbs, spine and hips. Osteoarthritis symptoms often develop slowly and worsen over time. Staying active and maintaining a healthy body weight can help better manage the occurrence of symptoms. Treatment modalities for this condition include medications and other therapeutic techniques. With changing guidelines, orthopedics medical billing and coding can be challenging. Outsourcing these tasks to a reliable medical billing and coding company that specializes in osteoarthritis coding can ensure the necessary support for accurate reimbursement. 

According to reports from the Arthritis Foundation about 31 million people in the United States live with the pain of osteoarthritis -- the wear-and-tear form of arthritis. Even though this condition can occur in adults of any age, the condition is most often seen in older adults. In fact, the likelihood of developing OA symptoms increases between the age group of 55-64 years. Possible risk factors include - aging, obesity, previous joint injury, overuse of the joint, weak muscles, and genetics. 

Osteoarthritis symptoms often develop slowly and worsen over time. Joint pain is one of the primary symptoms of this degenerative joint disease. However, if the pain lasts for more than two weeks, it is important to consult a pain management specialist. Other related symptoms include – joint stiffness, tenderness (discomfort when pressing on the area with the fingers), bone spurs, limited range of movement in the joints, grating or crackling sound or sensation in the joints, bony enlargements in the middle and end joints of the fingers and weakness and muscle wasting (loss of muscle bulk).  

Physicians as part of the initial diagnosis will perform a physical examination and closely examine the affected joints. They will check for tenderness, redness or swelling in the joints. In addition, several diagnostic imaging tests like X-Ray, MRI scan and lab tests like blood tests or joint fluid analysis will be performed to confirm the diagnosis. Treatment options involve a combined effort on the part of physical therapists, chiropractors, orthopedic physicians and rehabilitation specialists to assess patients and treat pain symptoms. Various non-invasive treatment modalities like physical therapy, non-steroidal anti-inflammatory (NSAIDs), chiropractic care and joint injections can help patients manage pain and treat joint stiffness and inflammation. 

Coding for Osteoarthritis

Pain management physicians, while diagnosing and treating this degenerative joint condition, must carefully document all the specific procedures using the right medical codes. Billing and coding services offered by experienced medical billing companies ensure this so that accurate claims submissions are done. 

20610 - Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidance

20611 - Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting

Degradation of joint cartilage is part of the natural aging process. While treatment modalities can help relieve OA symptoms to some extent, they cannot fully stop or slow joint degeneration.  However, it is possible to minimize the potential risks of developing OA with certain lifestyle changes. These include avoiding overuse of joints, keeping obesity at bay, and maintaining good posture. Adequate physical activity combined with the right medications can help strengthen muscles around the joints and make them more stable, thereby reducing pain. 

Medical billing and coding services offered by AAPC-certified coders can help orthopedists and pain management physicians optimize reimbursement for the services they offer. However, it is important to ensure that the coders are well-versed in the medical codes pertaining to the diagnosis and treatment of osteoarthritis and its related complications.

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