Current RMA Instruments
| Reasonable Hypothesis SOP | 13 of 2020 |
| Balance of Probabilities SOP | 14 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 730.1, 733.4
- ICD-10-AM Codes: K10.2, M87, M90.3, M90.4 or M90.5
Brief description
This SOP covers a disease in which localised death of bone tissue occurs. It most commonly involves the femoral head, but can affect multiple other sites, particularly joints in the limbs, vertebrae and jaw.
Confirming the diagnosis
The diagnosis will be based on clinical manifestations and imaging findings. An MRI scan is the most sensitive test. Plain X-rays and radionuclide bone scanning may also be used. In earlier cases, venography and bone biopsy may have been performed.
The relevant medical specialist is an orthopaedic surgeon.
Additional diagnoses covered by SOP
- Aseptic necrosis
- Atraumatic necrosis
- Avascular necrosis
- Dysbaric osteonecrosis
- Ischaemic necrosis
Conditions not covered by SOP
- Osteoarthritis*
- Osteochondrosis#
- Osteomyelitis#
- Osteoporosis*
* Another SOP applies
# Non-SOP condition
Clinical onset
The condition may be found incidentally on imaging performed for another reason, but more commonly the condition will present with pain in the affected joint or joints. The condition tends to be well advanced by the time of first presentation.
Clinical worsening
The only worsening factor is for inability to obtain appropriate clinical management. Treatment is aimed at preserving the native joint for as long as possible with conservative or surgical options. Joint replacement surgery will be or will become necessary in some cases.