ICD Code M16.12

ICD code M16.12 is used to identify a medical diagnosis of unilateral primary osteoarthritis affecting the left hip. This code is part of the International Classification of Diseases, 10th Revision (ICD-10), which is used by healthcare providers to document and categorize medical conditions for billing and statistical purposes. The code specifically indicates that the osteoarthritis is primary, meaning it is not caused by another disease or condition, and it affects only one hip, in this case, the left one.

When using the ICD code for unilateral primary osteoarthritis of the left hip, consider the following diagnostic criteria and symptoms:

1. Pain and Stiffness: Persistent pain localized to the left hip, often accompanied by stiffness, particularly after periods of inactivity or in the morning.

2. Reduced Range of Motion: Noticeable limitation in the range of motion of the left hip joint, impacting daily activities such as walking, bending, or sitting.

3. Crepitus: Audible or palpable creaking or grating sensation in the left hip joint during movement.

4. Joint Tenderness: Tenderness upon palpation of the left hip joint, indicating inflammation or degeneration.

5. Radiographic Evidence: X-ray or MRI findings showing joint space narrowing, osteophyte formation, or subchondral sclerosis specifically in the left hip.

6. Exclusion of Secondary Causes: Absence of other underlying conditions or factors that could cause osteoarthritis, such as trauma, congenital abnormalities, or inflammatory joint diseases.

7. Age and Risk Factors: Consideration of patient age, typically middle-aged or older, and other risk factors such as obesity, previous joint injuries, or genetic predisposition.

8. Functional Impairment: Assessment of the impact on the patient's ability to perform daily activities, indicating significant functional impairment due to the condition.

By evaluating these criteria, healthcare providers can accurately determine the use of the ICD code for unilateral primary osteoarthritis of the left hip.

For the ICD code M16.12, which pertains to unilateral primary osteoarthritis of the left hip, the relevant CPT codes that may be applicable for treatment include:

1. 27130 - Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty) with or without autograft or allograft.

2. 27132 - Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft.

3. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., hip, knee, shoulder joint); without ultrasound guidance.

4. 20611 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., hip, knee, shoulder joint); with ultrasound guidance, with permanent recording and reporting.

5. 29862 - Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty).

6. 29863 - Arthroscopy, hip, surgical; with synovectomy.

These CPT codes are commonly associated with procedures that may be performed to address the condition identified by ICD code M16.12. It is important for healthcare providers to select the appropriate CPT code based on the specific treatment or procedure performed.

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments for CPT codes associated with ICD code M16.12. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.