2025 ICD-10-CM code M89.7
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Osteopathies and chondropathies - Other osteopathies (M86-M90) Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Major osseous defect; an imperfection or absence of bone structure integrity due to excessive bone loss.
Modifiers may be applied depending on the specific circumstances of the encounter and the procedures performed (e.g., modifiers for laterality, multiple procedures).
Medical necessity for treatment of a major osseous defect is established based on the severity of the defect and its impact on the patient’s function.The clinical documentation should support the need for intervention by demonstrating significant pain, impairment of daily activities, or risk of further complications such as instability or infection.The choice of treatment (e.g., surgery, conservative management) must be medically appropriate based on the individual patient's condition.
Diagnosis and treatment of major osseous defects involves a multidisciplinary approach.The physician's role includes taking a comprehensive patient history, performing a physical examination to assess range of motion and signs of fracture, ordering and interpreting imaging studies (X-rays, MRI, CT, bone scans), ordering blood tests to evaluate for inflammation (ESR), and potentially performing a biopsy. Treatment may involve prescribing analgesics, corticosteroids, or NSAIDs, recommending nutritional supplements, and referring the patient for physical therapy. The physician determines the need for surgical intervention.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Osteopathies and chondropathies (M80-M94); Other osteopathies (M86-M90)
In simple words: A major osseous defect is a significant problem with a bone, where a part is missing or damaged due to bone loss. This can happen after joint replacement surgery, because of cancer, weak bones (osteoporosis), or injury. It can cause pain, swelling, and stiffness. Doctors use X-rays and other scans to diagnose it, and treatment might include medicine, physical therapy, or surgery.
A major osseous defect is characterized by an imperfection or absence of bony structure integrity resulting from excessive bone loss.This can be caused by various factors including implant failure in joint replacement, benign or malignant neoplasms, osteoporosis, or trauma. The defect may manifest as pain, swelling, deformity, inflammation, or fractures, potentially leading to restricted movement and, in some cases, neurologic complications from nerve compression. Diagnosis involves patient history, physical examination (assessing range of motion and fractures), imaging (X-rays, MRI, CT scans, bone scans), blood tests (erythrocyte sedimentation rate), and potentially a biopsy. Treatment options range from medication (analgesics, corticosteroids, NSAIDs), nutritional supplements (calcium), physical therapy, and addressing the underlying condition, which may necessitate surgery.
Example 1: A 65-year-old female presents with persistent pain and limited mobility in her right hip following a total hip arthroplasty six months prior. Imaging reveals a significant periprosthetic osteolysis and a major osseous defect.The physician orders additional blood work and considers revision surgery., A 40-year-old male with a history of osteosarcoma undergoes surgical resection of a bone tumor in his left femur. Post-operative imaging shows a large osseous defect. The orthopedic surgeon develops a treatment plan involving bone grafting and possibly an implant., A 78-year-old female with osteoporosis suffers a pathologic fracture of her right humerus. The fracture results in a significant osseous defect.Treatment focuses on fracture stabilization and medication to improve bone density.
Detailed patient history including onset and nature of symptoms, prior medical conditions, and any trauma.Complete physical examination documenting range of motion, presence of deformity or swelling, neurologic assessment if indicated.Imaging reports (X-rays, MRI, CT scans, bone scans) clearly showing the extent of the osseous defect.Laboratory results (e.g., ESR).Biopsy report if performed.Detailed surgical report if any surgical intervention is undertaken. Treatment plan and progress notes.
** This code is used to report a significant bone defect.It's crucial to document the etiology (cause) of the defect for accurate coding and reimbursement.
- Payment Status: Active
- Specialties:Orthopedic Surgery, Oncology, Rheumatology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office