ICD-10 Coding for Orthopedic Surgery

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ICD-10 Coding for Orthopedic Surgery Due to the higher level of specification, ICD-10-CM/PCS coding for orthopedic surgery has to be done meticulously and with minute attention to detail.

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Due to the higher level of specification, coding for orthopedic surgery in keeping with ICD-10-CM/PCS has to be done meticulously with minute attention to detail. For instance, the new coding system requires more specific information regarding a fracture when choosing the

fracture

codes.

There

are

vital

changes

in

coding

the

complications of device as well as the surgical procedure.

Fracture Codes Here, we are considering hip fractures to understand the changes that have occurred in selecting fracture codes under the new coding system.

In

ICD-9

coding

of

hip

fractures,

there

are

some

specifications regarding the site of femoral fracture. But ICD-10-CM goes further to provide information about the laterality. The ICD-9 code for fracture of neck of femur (hip fracture) is 820. It is further classified into several codes according to the specifications pertaining to the site of femoral fracture. Some of them are given below. 

820.00: Closed fracture of intracapsular section of neck of femur,

unspecified 

820.01: Closed fracture of epiphysis (separation) (upper) of neck

of femur 

820.02: Closed fracture of midcervical section of neck of femur



820.03: Closed fracture of base of neck of femur

The following ICD-10 codes specify the laterality (right or left) along with the specifications regarding the site.  S72.011A: Unspecified intracapsular fracture of right femur, initial encounter for closed fracture  S72.012A: Unspecified intracapsular fracture of left femur, initial encounter for closed fracture  S72.019A:

Unspecified

intracapsular

fracture

of

unspecified

femur, initial encounter for closed fracture The episode of care information is coded using separate codes in the ICD-9 system while ICD-10 coding specifies that information with the seventh character. For example, the following ICD-9 code is used separately after the hip fracture code, say, 820.00 to specify the healing regardless of whether it is routine healing or delayed healing. 

V54.13: Aftercare for healing traumatic fracture of hip

This information can be specified with the appropriate hip fracture code in ICD-10 itself. 

S72.019D: Unspecified intracapsular fracture of unspecified

femur, subsequent encounter for closed fracture with routine healing 

S72.019G: Unspecified intracapsular fracture of unspecified

femur, subsequent encounter for closed fracture with delayed healing

Since the episode of care information is included within the fracture code, it will improve the data analysis and the reviewer can identify the number of hip fractures that occurred previously, how many of them are in acute phase, how many of them are in the healing phase and whether there are any complications.

There are separate codes for nonunion and malunion of fractures in ICD-9 such as:  733.81: Malunion of fracture  733.82: Nonunion of fracture However, the fracture codes within ICD-10 system specify this information also.  S72.012K: Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with nonunion  S72.012P: Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with malunion In short, the coder should consider the laterality, episode of care, nonunion and malunion of fractures while choosing the appropriate fracture code under ICD-10.

Complications Associated with a Device The complication type such as loosening, pain, prosthetic fracture, infection, misalignment etc. should be documented clearly in the clinical information. The joint replacement status needs to be considered

in

both

classification

systems.

However,

there

is

difference in coding the complications in each coding system. Let’s take the example of a complication, mechanical loosening of prosthetic joint and the problem area is the hip joint. There are two codes in the ICD-9 system to represent the complication and joint replacement status.

 996.41: Mechanical loosening of prosthetic joint  V43.64: Hip joint replacement Coders need not assign a separate code for joint replacement status under ICD-10. However, they should consider the laterality, the exact site, and the episode of care to choose the appropriate code for complication.  T84.030: Mechanical loosening of internal right hip prosthetic joint  T84.030A: Mechanical loosening of internal right hip prosthetic joint, initial encounter  T84.030D: Mechanical loosening of internal right hip prosthetic joint, subsequent encounter  T84.030S: Mechanical loosening of internal right hip prosthetic joint, sequela

 T84.031: Mechanical loosening of internal left hip prosthetic joint  T84.031A: Mechanical loosening of internal left hip prosthetic joint, initial encounter  T84.031D: Mechanical loosening of internal left hip prosthetic joint, subsequent encounter  T84.031S: Mechanical loosening of internal left hip prosthetic joint, sequela Arthroplasty For the arthroplasty procedure, there are three root operation choices such as repair, replacement and supplement. It is very important for the coder to understand the goal of the procedure to select the appropriate procedure code. The original replacement of the

joint

should

be

coded

with

the

root

operation

of

the

replacement. The root operation is repair while the physician is restoring the joint without any device and supplement while the surgeon is reinforcing the joint without removing the joint. In the ICD-9 system, it is easy to code for this procedure as it is required to just consider arthroplasty and review the subentries for the joint.

Medical coders may need to know whether the replacement was complete or partial. In the ICD-10 system, coders will require to know about the type of device inserted, whether that device is cemented or uncemented and the specific body part including the laterality, apart from the root operation. Here are knee arthroplasty codes that specify laterality.

 Z96.651: Presence of right artificial knee joint  Z96.652: Presence of left artificial knee joint Clinical

documentation

should

provide

proper

and

accurate

information regarding the site of fractures, the surgical procedure and complications associated with the device so that the coders can assign the most appropriate ICD-10 codes. When it comes to implants, orthopedic practices should determine whether physician documentation or a device record is the source of facts regarding the type of implant inserted. As the implementation date is approaching, orthopedic practices should make necessary changes to their clinical documentation and documentation policies to adopt the coding

changes

and

avoid

revenue

loss.

They

can

provide

comprehensive training for their coders in ICD-10 or seek the services of professional coders having thorough knowledge in ICD-10.