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ICD-10 Guide
ICD-10 CodesM67.20

M67.20

Billable

Synovial hypertrophy, not elsewhere classified, unspecified site

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

Code Description

ICD-10 M67.20 is a billable code used to indicate a diagnosis of synovial hypertrophy, not elsewhere classified, unspecified site.

Key Diagnostic Point:

Synovial hypertrophy refers to the abnormal enlargement of the synovial membrane, which lines the joints and tendon sheaths. This condition can arise from various underlying causes, including inflammatory processes, mechanical stress, or degenerative changes. Synovial hypertrophy is often associated with conditions such as rheumatoid arthritis, osteoarthritis, and tenosynovitis, where the synovial tissue becomes inflamed and thickened. Clinically, patients may present with joint swelling, pain, and reduced range of motion. The unspecified site designation indicates that the hypertrophy is not localized to a specific joint or tendon sheath, making it essential for clinicians to conduct thorough evaluations to determine the underlying cause. Treatment may involve corticosteroid injections, physical therapy, or surgical interventions, such as synovectomy, to alleviate symptoms and restore function. Accurate coding of synovial hypertrophy is crucial for proper management and reimbursement, as it reflects the complexity of the patient's condition and the need for targeted therapeutic approaches.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and underlying causes
  • Need for thorough documentation to specify the site and nature of hypertrophy
  • Potential overlap with other synovial disorders
  • Differentiation from other inflammatory conditions

Audit Risk Factors

  • Inadequate documentation of the site of hypertrophy
  • Failure to specify associated conditions or symptoms
  • Misuse of unspecified codes leading to potential denials
  • Lack of clarity in the clinical rationale for treatment

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed history of joint symptoms, physical examination findings, and imaging results.

Common Clinical Scenarios

Patients with chronic joint pain and swelling, particularly in the context of autoimmune diseases.

Billing Considerations

Ensure that all relevant comorbidities and treatment responses are documented to support the diagnosis.

Orthopedics

Documentation Requirements

Surgical notes, pre-operative assessments, and post-operative follow-ups.

Common Clinical Scenarios

Patients undergoing surgical interventions for synovial hypertrophy or related conditions.

Billing Considerations

Document the specific surgical procedures performed and any complications encountered.

Coding Guidelines

Inclusion Criteria

Use M67.20 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the specific site of synovial hypertrophy is not documented
  • Include additional codes for any underlying conditions or associated symptoms

Exclusion Criteria

Do NOT use M67.20 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used when performing joint injections for symptomatic relief of synovial hypertrophy.

Documentation Requirements

Document the indication for the procedure, the joint involved, and the volume of fluid aspirated or injected.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to the diagnosis of synovial hypertrophy.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like synovial hypertrophy, improving the accuracy of clinical documentation and reimbursement processes. However, the unspecified nature of M67.20 may lead to challenges in justifying treatment and may result in increased scrutiny during audits.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like synovial hypertrophy, improving the accuracy of clinical documentation and reimbursement processes. However, the unspecified nature of M67.20 may lead to challenges in justifying treatment and may result in increased scrutiny during audits.

Reimbursement & Billing Impact

reimbursement processes. However, the unspecified nature of M67.20 may lead to challenges in justifying treatment and may result in increased scrutiny during audits.

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 is the significance of using M67.20?

M67.20 is significant as it captures cases of synovial hypertrophy that do not fit into more specific categories, allowing for appropriate management and treatment planning.