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ICD-10 Guide
ICD-10 CodesM87.221

M87.221

Billable

Osteonecrosis due to previous trauma, right humerus

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

Code Description

ICD-10 M87.221 is a billable code used to indicate a diagnosis of osteonecrosis due to previous trauma, right humerus.

Key Diagnostic Point:

Osteonecrosis, also known as avascular necrosis, is a condition characterized by the death of bone tissue due to a lack of blood supply. In the case of M87.221, the osteonecrosis is specifically attributed to previous trauma affecting the right humerus. This condition often arises after fractures or dislocations that compromise the blood supply to the bone. Symptoms may include pain in the shoulder, limited range of motion, and potential joint dysfunction. Diagnosis typically involves imaging studies such as X-rays or MRI to assess the extent of bone damage and to rule out other conditions like osteomyelitis or bone infections. Treatment options may vary from conservative management, including pain relief and physical therapy, to surgical interventions such as core decompression or joint replacement, depending on the severity of the necrosis. Understanding the underlying cause of osteonecrosis is crucial for effective management and prevention of further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of the relationship between trauma and osteonecrosis.
  • Differentiation from other bone conditions like osteomyelitis.
  • Need for precise documentation of prior trauma.
  • Potential for multiple codes if complications arise.

Audit Risk Factors

  • Inadequate documentation of prior trauma.
  • Failure to specify the affected site (right humerus).
  • Misclassification with osteomyelitis or other bone disorders.
  • Lack of imaging studies to support diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of trauma, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with shoulder pain post-fracture, limited mobility, or chronic pain.

Billing Considerations

Ensure clear documentation of the mechanism of injury and any prior treatments.

Radiology

Documentation Requirements

Imaging reports indicating the presence of osteonecrosis and any differential diagnoses.

Common Clinical Scenarios

Imaging studies performed for patients with suspected osteonecrosis.

Billing Considerations

Accurate reporting of findings to support the diagnosis and coding.

Coding Guidelines

Inclusion Criteria

Use M87.221 When
  • According to ICD
  • 10 coding guidelines, M87
  • 221 should be used when osteonecrosis is specifically due to previous trauma
  • Coders must ensure that the documentation supports the diagnosis and that the trauma is clearly described

Exclusion Criteria

Do NOT use M87.221 When
  • Exclusion criteria include conditions not related to trauma or those that do not involve the right humerus

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used when surgical intervention is required for osteonecrosis.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery.

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 osteonecrosis, improving the accuracy of data collection and reimbursement processes. M87.221 provides specificity that was not available in ICD-9, enhancing clinical understanding and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like osteonecrosis, improving the accuracy of data collection and reimbursement processes. M87.221 provides specificity that was not available in ICD-9, enhancing clinical understanding and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. M87.221 provides specificity that was not available in ICD-9, enhancing clinical understanding and treatment planning.

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 primary cause of osteonecrosis in this code?

The primary cause of osteonecrosis in M87.221 is previous trauma to the right humerus, which disrupts blood supply to the bone.