2017 ICD-10-CM: Updates and Challenges for Orthopedics Presented By: Rachel M. Kaser, BS, CPC, MHSA AHIMA-Approved ICD-10-CM/PCS Trainer Auditor; The Coding Institute (TCI)
Course Objectives • Recognize new, revised, deleted ICD-10-CM codes taking effect October 1, 2016 pertaining to Orthopedic practices • Avoid setbacks to reimbursement • Utilize expert orthopedic specific tools to accurately select codes necessary for compliance and maximum reimbursement
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ICD-10-CM Updates • Of Note: • The Addenda that was published in June is the complete, final list of code changes going into effect this October
• Ensure your Orthopedic practice reviews the Addenda and makes note of any and all changes!
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ICD-10-CM Updates • Much needed ICD-10-CM changes/clarifications: • 885 new codes added to Chapter 19 (Injuries Chapter) • Increased site specificity for fracture codes of the following sites: neck, base of skull, facial bones, Salter-Harris calcaneal fractures, and other fractures.
• 152 new codes added to Chapter 13 (Musculoskeletal Chapter) • Additional classifications for bunions, temporomandibular joint conditions, cervical spine disorders and atypical femoral fractures
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ICD-10-CM Updates • Much needed ICD-10-CM changes/clarifications: • Guidance on the 7th character applications in Chapter 19 • When aftercare Z codes are appropriate instead of injury codes as it pertains to Orthopedics
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Medical Necessity • Ensure medical necessity is met for: • • • • • •
Hip and knee replacements Arthoscopic femoral acetabular impingement repairs Knee Arthroscopies Pelvic ring fractures Hip fractures Femur fractures
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Seventh Characters • You’ll apply a seventh character to these codes from the following list: • • • • • •
A – initial encounter for fracture D – subsequent encounter for fracture with routine healing G – subsequent encounter for fracture with delayed healing K – subsequent encounter for fracture with nonunion P – subsequent encounter for fracture with malunion S – sequela
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Atypical Fractures • Rationale: • Atypical fracture
• Fosamax fracture • May refer to an atypical fracture
• Track all such atypical femoral fractures
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Atypical Fractures • Defining as Fosamax Fracture: • Large population of patients may be missed • These fractures can occur in absence of taking these drugs
• Review clinical documentation to verify codes are not unspecified • Best practice includes: • Providing ongoing clinical documentation improvement • Providing feedback to the physician including guidance on capturing the specific data requirements
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Atypical Fracture Codes • ICD-10: Adopt These New Atypical Fracture Diagnoses Starting October 1: • • • • • • • • • •
M84.750: M84.751: M84.752: M84.753: M84.754: M84.755: M84.756: M84.757: M84.758: M84.759:
Atypical femoral fracture, unspecified Incomplete atypical femoral fracture, right leg Incomplete atypical femoral fracture, left leg Incomplete atypical femoral fracture, unspecified leg Complete transverse atypical femoral fracture, right leg Complete transverse atypical femoral fracture, left leg Complete transverse atypical femoral fracture, unspecified leg Complete oblique atypical femoral fracture, right leg Complete oblique atypical femoral fracture, left leg Complete oblique atypical femoral fracture, unspecified leg
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ICD-10-CM Updates • FY 2017: • The new codes are M and S for Orthopedics • Over thousands of new codes added to this specialty!
• Brand new codes for Salter-Harris fractures • Addition of completely new, necessary codes within this specialty • New syntax for existing codes
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