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v1.0.0
ICD-10 Guide
ICD-10 CodesM21.92

M21.92

Billable

Unspecified acquired deformity of upper arm

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M21.92 is a billable code used to indicate a diagnosis of unspecified acquired deformity of upper arm.

Key Diagnostic Point:

The ICD-10 code M21.92 refers to an unspecified acquired deformity of the upper arm, which can arise from various causes such as trauma, surgery, or underlying medical conditions. Acquired deformities may manifest as changes in the bone structure, muscle tone, or joint alignment, leading to functional limitations and aesthetic concerns. Common causes include fractures that heal improperly, neurological conditions affecting muscle control, or conditions like arthritis that alter joint integrity. The upper arm's anatomy includes the humerus bone, muscles, and connective tissues, all of which can be affected by these deformities. Patients may experience pain, reduced range of motion, and difficulty performing daily activities. Treatment options often involve physical therapy, orthopedic interventions, or surgical correction, depending on the severity and nature of the deformity. Accurate coding is essential for appropriate management and reimbursement, as well as for tracking the prevalence of these conditions in clinical practice.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of deformities
  • Need for detailed documentation to specify the nature of the deformity
  • Potential overlap with other musculoskeletal codes
  • Variations in treatment approaches based on underlying causes

Audit Risk Factors

  • Inadequate documentation of the deformity's cause
  • Failure to specify the type of acquired deformity
  • Inconsistent coding practices among providers
  • Lack of follow-up documentation to support ongoing treatment

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed descriptions of the deformity, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with post-fracture deformities, congenital deformities, or post-surgical complications.

Billing Considerations

Ensure that the documentation clearly states the acquired nature of the deformity and any associated conditions.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, therapy progress notes, and patient-reported outcomes.

Common Clinical Scenarios

Patients undergoing rehabilitation for upper arm deformities due to stroke or trauma.

Billing Considerations

Focus on the impact of the deformity on daily activities and the goals of rehabilitation.

Coding Guidelines

Inclusion Criteria

Use M21.92 When
  • According to ICD
  • 10 guidelines, M21
  • 92 should be used when the specific nature of the acquired deformity is not documented
  • Coders should ensure that the documentation supports the use of this code and consider additional codes for underlying conditions

Exclusion Criteria

Do NOT use M21.92 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

25447CPT Code

Osteotomy of the humerus

Clinical Scenario

Used for correcting deformities of the upper arm.

Documentation Requirements

Pre-operative assessments, surgical notes, and post-operative follow-ups.

Specialty Considerations

Orthopedic surgeons should document the rationale for surgery and expected outcomes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of acquired deformities, improving the ability to track treatment outcomes and resource allocation. M21.92 provides a general classification that can be refined with additional codes for underlying conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of acquired deformities, improving the ability to track treatment outcomes and resource allocation. M21.92 provides a general classification that can be refined with additional codes for underlying conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of acquired deformities, improving the ability to track treatment outcomes and resource allocation. M21.92 provides a general classification that can be refined with additional codes for underlying conditions.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What documentation is needed to support the use of M21.92?

Documentation should include a detailed description of the deformity, its cause, any associated conditions, and the treatment plan. Imaging studies and clinical assessments are also important.