Osteoporosis has recently been identified as the most prevalent metabolic disease of the bone structure. Millions of people, just in United States alone, either already have been diagnosed with osteoporosis or have lower than normal bone density levels which puts them at a greater risk of serious fractures.
The situation is not better if you look at the world-wide statistics – this time we are talking about hundreds of millions of women and men that have already been affected by osteoporosis.
Osteoporosis can be divided into two main categories: primary and secondary. Within these two groups, each classification will have its own diagnosis code for osteoporosis. The globally used ICD code for osteoporosis is ICD 9 730.00 (which could also indicate the unspecified or other types of osteoporosis).
Most cases of diagnosed osteoporosis in both women and man fall into this category. This group can further be separated in three distinct types of primary osteoporosis: postmenopausal, senile and idiopathic osteoporosis.
Type 1 Osteoporosis (Postmenopausal)
This type of primary osteoporosis is also known as postmenopausal osteoporosis and it typically occurs in women as a result of reduction in estrogen levels and usually between the ages of 50 and 70.
In men, this tends to happen because of the testosterone deficiency and the most common type of fractures are experienced in distal forearm (bones of the forearm near the wrist) and in the vertebrae.
ICD 9 Code For osteoporosis in this case is 733.01.
Type 2 Osteoporosis (Senile)
Senile osteoporosis is considered to occur because of the deficiency of calcium detected in both men and women older than 70 years. This condition is associated with normal aging process and the common fractures seen in people diagnosed with this type are pelvic and hip fractures. Senile osteoporosis is classified under ICD 9 code 733.01.
Type 3 Osteoporosis (Idiopathic)
Idiopathic osteoporosis usually affects mostly young adults and children, but there were some cases reported in older individuals as well. These patients tend to have completely normal hormone and vitamin levels in their bodies and no obvious reasons for the weakened bone structure. The idiopathic osteoporosis falls under ICD 9 code 733.02.
This type of osteoporosis occurs because of an existence of some other underlying disease like nutritional deficiency in one or more vitamins and minerals, certain blood disorders, diabetes, hereditary reasons, kidney disease, intestinal absorption complications etc.
Secondary osteoporosis can also be caused by the long-term regimen of some prescription medication combinations. Some of these medications might include chemotherapy drugs, medications to prevent seizures, heparin, steroids, antacids containing aluminum and some hormonal treatments. This type is also known as Drug-Induced Osteoporosis and is classified under ICD 9 code 733.09.
Another kind of secondary osteoporosis is Disuse Osteoporosis and, as the name suggests, it might occur if there is no weight bearing on lower extremities for longer periods of time. Typical scenarios would be in the cases of bone immobilization or complete disuse (hemiplegia). Disuse osteoporosis ICD 9 code is 733.03.
Osteoporosis and Curvature of the Spine
In cases where the person diagnosed with osteoporosis also has the curvature of the spine at the same time then the medical professionals might use these additional ICD 9 codes in addition to the original one:
Kyphosis (ICD 9 Code 737.41) – convex thoracic spine
Lordosis (ICD 9 Code 737.42) – concave lumbar spine;
Scoliosis (ICD 9 Code 737.43) – spine lateral curvature
Unspecified (ICD 9 Code 737.40)
Other Osteoporosis Codes
Osteoporosis Circumscripta (ICD 9 Code 731.0)
Post-traumatic Osteoporosis (ICD 9 Code 733.7) – covers the disuse bone atrophy
Wedging of Vertebra NOS (ICD 9 Code 733.00)
Osteoporosis has no symptoms until a fracture occurs, which causes bone pain, height loss, and abnormal spine curvature. If a fracture is determined to be due to osteoporosis, it is considered a pathological fracture, which is a break of a diseased or weakened bone without any identifiable trauma or following a minor injury that would not ordinarily break a healthy bone.
A pathological fracture is classified to ICD 9 code 733.1x, with a fifth digit identifying the fracture site. Osteoporotic fractures often occur in the vertebra (ICD 9 Code 733.13), hip (ICD 9 Code 733.14), or wrist (distal radius or Colles’ fracture, ICD 9 Code 733.12).
However, because a patient has a bone-weakening condition does not mean a fracture is pathologic. Only the physician can determine whether the fracture is traumatic or pathologic, and physician documentation must be obtained to clarify.
The following terms are synonymous with pathological fracture: spontaneous fracture, insufficiency fracture, non-traumatic fracture, and non-traumatic compression fracture. When one of these terms is documented, a value from subcategory ICD 9 Code 733.1 may be assigned instead of any values from 800 to 820. If the physician documents stress fracture, assign one of the following codes:
- ICD 9 Code 733.93, Stress fracture of tibia or fibula;
- ICD 9 Code 733.94, Stress fracture of the metatarsals;
- ICD 9 Code 733.95, Stress fracture of other bone;
- ICD 9 Code 733.96, Stress fracture of femoral neck;
- ICD 9 Code 733.97, Stress fracture of shaft of femur; or
- ICD 9 Code 733.98, Stress fracture of pelvis.
The sequencing of osteoporosis and pathological fracture depends on the circumstances of admission. If a patient is admitted to treat the pathological fracture rather than osteoporosis, the fracture should be sequenced first, followed by the value for osteoporosis.
Compression fractures may be considered traumatic (work or sports related) or pathologic (due to disease process).
Coding and sequencing for osteoporosis are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.