February 18 , 2008

Coding for Tendonitis
For The Record
Vol. 20 No. 4 P. 32

Tendonitis is the inflammation or irritation of a tendon, which is a thick fibrous cord that attaches muscles to bones. Although tendonitis can occur anywhere in the body, it is most common around the shoulders, elbows, wrists, and heels.

Tendonitis is caused by injury and overuse and may be severe enough to rupture and require surgical repair. However, most tendonitis cases are treated with rest and medication.

Symptoms
Pain, tenderness, and mild swelling are common signs and symptoms of tendonitis. Tendonitis is aggravated by movement, and the pain is typically worse during activities using the muscles involved with that tendon.

Types of Tendonitis
The following are specific types of tendonitis with their corresponding ICD-9-CM code:

• Tennis elbow (726.32) — causes pain on the outer side of the forearm near the elbow when the forearm is rotated.

• Golfer’s elbow (726.32) — causes pain on the inner part of the elbow.

• Achilles tendonitis (726.71) — causes pain just above the heel.

• Patellar tendonitis (726.64) — causes pain just below the knee cap.

• Rotator cuff tendonitis — causes shoulder pain. If the shoulder tendonitis is specified as adhesive, assign code 726.0. Calcifying or calcific tendonitis of the shoulder is classified to code 726.11. If the shoulder tendonitis is not further specified, assign code 726.10.

• Tibialis tendonitis (726.72) — causes ankle pain. Code 726.72 includes tendonitis of the anterior and posterior tibia.

• Tendonitis of the hip region (726.5) — includes tendonitis of the gluteal, psoas, and trochanteric tendons.

Occasionally, the tendon sheath becomes scarred and narrowed in small joints (eg, fingers) and may cause the tendon to lock in one position. This is called trigger finger and is classified to code 727.03. The procedure code assignment for the release of the trigger finger is code 82.01.

Nontraumatic tendon rupture is classified to one of the following codes:

• 727.60, Nontraumatic rupture of unspecified tendon;

• 727.61, Complete rupture of rotator cuff;

• 727.62, Tendons of biceps (long head);

• 727.63, Extensor tendons of hand and wrist;

• 727.64, Flexor tendons of hand and wrist;

• 727.65, Quadriceps tendon;

• 727.66, Patellar tendon;

• 727.67, Achilles tendon;

• 727.68, Other tendons of foot and ankle; and

• 727.69, Nontraumatic rupture of other specified tendon.

A tendon rupture due to an old traumatic injury is classified to code 718.9x. A fifth digit is required to identify the site involved.

Diagnosis
The physician may perform the following tests after a thorough history and physical exam:

• X-ray — although not helpful in confirming tendonitis because tendons are generally not visible, x-rays are used to rule out more serious conditions involving the bone.

• MRI — may be done to determine weakening or tearing of the tendon or changes in the tendon sheath or covering.

• Blood tests — to rule out rheumatoid arthritis.

Treatment
The main goals of treating tendonitis are relieving pain and reducing inflammation, and most cases can be treated at home with rest, ice, or over-the-counter pain relievers, including non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and acetaminophen. Other treatment may include corticosteroid injections around the tendons, topical corticosteroids applied to the painful area and pulled through the skin by iontophoresis, physical therapy to strengthen the area, or surgery to repair tear and reduce pain and restore function

Coding and sequencing for tendonitis 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.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.