Medical billing and coding can be a complicated process. In order to get the appropriate bills, you must have the correct diagnosis code. In the medical world, this is referred to as an ICD-10 code. Most diagnoses are simply listed under their name, which makes it simpler for medical professionals and patients alike.
However, it's not so simple for Dupuytren's because it's listed as something else. If you've read our other articles, you may remember that Dupuytren's is also called palmar fibromatosis. This is what the condition is called, which means it is the ICD-10 code M72.0 and is found under the heading "Contraction(s), contracture, contracted."
M72.0 can be found under chapter 13 of the ICD-10 tabular list, which is called "diseases of the musculoskeletal system and connective tissue" and spans from M00-M99. Dupuytren's falls under the M70-M79 block that contains soft tissue disorders. When referencing category M72 (fibroblastic disorders), you’ll see a red note that lets the user know this category's codes require a fourth character.
As you move down to M72.0 (palmar fascial fibromatosis), you’ll see several notes. The first note (also the easiest to miss) is the letter A in a small orange box. This symbol means that M72.0 is an adult code, so it should only be assigned to patients at least 15 years of age.
The second note is under code M72.0, and it's the definition of Dupuytren’s contracture. The ICD-10 book defines Dupuytren’s contracture as a flexion deformity of a finger that develops due to shortened, thickened palmar fascia. The book goes on to say that the cause of Dupuytren’s contracture is unknown, but it is associated with long-standing epilepsy.
After checking all notes and symbols surrounding the category and the code in the tabular list, you have successfully verified the ICD-10 code for Dupuytren’s contracture.
When assigning ICD-10 codes, it’s important only to code for confirmed (diagnosed) cases of Dupuytren’s contracture. A physician’s diagnostic statement of Dupuytren’s contracture in the medical record is sufficient to assign the ICD-10 code to a person's documentation.
ICD-10-CM guideline #2 is listed as an "uncertain diagnosis" and states that there is specific wording for patients seen in outpatient settings (doctor's offices, urgent care clinics, etc.). Examples of diagnostic statements that you cannot code as confirmed cases of Dupuytren’s contracture include:
Some of these statements are clinically diagnostic and are sufficient for a doctor to begin a patient’s treatment for Dupuytren’s contracture. However, according to ICD-10-CM coding guidelines, these statements do not confirm a diagnosis. You cannot code Dupuytren’s contracture based on any of the above documentation.
Inpatient settings (such as hospitals) have slightly different rules. However, Dupuytren’s diagnoses typically happen on an outpatient basis, so those rules don’t apply and aren’t relevant here.
ICD-10-CM Guideline I.B.4. (signs and symptoms) states that you should code the patient’s signs and symptoms only if the physician’s documentation does not include a definitive diagnosis. The physician’s documentation may lack a definitive diagnosis because they used a clinically diagnostic statement (like one of the above examples) that cannot be used for coding purposes.
It’s also possible that the physician did not have enough information about the patient’s condition to diagnose them. They may send the patient for further testing or wait and observe the condition before making a diagnosis. Let’s review coding for the signs and symptoms of Dupuytren's.
Codes that are followed by a dash and a checkmark in the index are incomplete codes. Those symbols indicate that you absolutely must verify those codes in the tabular list to get the additional characters and complete the code.
ICD-10-CM Guideline I.B.5. states that if the physician’s documentation meets the criteria for a definitive diagnosis, you should code Dupuytren’s contracture, but not the symptoms associated with Dupuytren’s.
The basis is that, if you code a definitive diagnosis, we expect that the patient has the signs and symptoms of that condition, so it's redundant to add those codes. However, ICD-10-CM Guideline I.B.6. states that, if the patient is experiencing symptoms that are not an integral part of the disease process, you should code those symptoms in addition to Dupuytren’s contracture.
Diagnostic coding for Dupuytren’s contracture can be tricky. However, if you follow ICD-10-CM guidelines carefully and mind all the exceptions in your codebook, the process becomes much simpler.