Orthopedic Coding
For reimbursement and to substantiate the medical necessity for their services, Orthopedic surgeons will be required to use ICD-10-CM .Significant changes in the clinical and administrative processes of orthopedic offices and hospital practices will be required for implementation of ICD-10. Orthopedic surgeons can mitigate the anticipated changes and reduce the potential impact these changes will have on their practices, through education and planning. By using anatomically precise nomenclature and obtaining a more detailed history and physical examination, the accuracy and specificity of their documentation. This will require evoking external causes of patients’ problems, the precise activity of causation, and the place of occurrence.
In ICD-10-CM, there are three main categories of changes:
- Definition Changes
- Terminology differences
- Increased specificity
The focus is on increased specificity, for Orthopedics. The expansion of ICD-10 codes is due to the addition of laterality (left, right, or bilateral). Physicians shouldn?t assume that compliance will be impossible, although ICD-10 includes a set of changes for the orthopedic specialty.
Site specificity
Many of the orthopedic diagnoses will require to mention the Site specificity in ICD-10 :
- Regions of the spine: Many diagnoses, such as spondylosis (M47.-), spinal stenosis (M48.0-), and osteomyelitis (M46.2-), require physicians to document the specific region of the spine. These regions include:
- Occipito-atlanto-axial,
- Cervical, cervicothoracic,
- Thoracic, thoracolumbar,
- Lumbar, lumbosacral,
- Sacral and sacrococcygeal, or multiple sites.
- Osteoarthritis with or without current pathologic fracture (M80.- and M81.- respectively): Documentation must specify hip, knee, first carpometacarpal joint, shoulder, elbow, wrist, hand, ankle, or foot. Physicians must also document the type of osteoporosis?that is
- Age-related,
- Localized, or
- Other (drug-induced, idiopathic, of disuse, postoophorectomy, post-surgical malabsorption, or post-traumatic).
- For drug-induced osteoporosis, identify the specific drug that caused the adverse effect (i.e., the osteoporosis).
- Chronic gout (M1A.-): Documentation must specify shoulder, elbow, wrist, hand, hip, knee, ankle, foot, vertebrae, or multiple sites.
Physicians must also document laterality as well as the type of chronic gout?that is
- Idiopathic,
- Lead-induced,
- Drug-induced, due to renal impairment, or
- Other secondary chronic gout.
Laterality
Specifying right, left, or bilateral in ICD-10 changes for the orthopedic specialty pertain to laterality. ICD-9 codes did not have this.
Type of encounter
When documenting fracture care, Orthopedists must provide sufficient information whether the encounter is initial, subsequent, or sequela (i.e., a residual effect after the normal healing period). The 7th character in the ICD-10 fracture care code is reported for this information. Physicians must specify routine healing, delayed healing, malunion, or nonunion for subsequent encounters.
Combination codes
Physicians should be aware of the few combination codes in ICD-10. For example, lumbago with sciatica is coded as ICD-10 code M54.4. It is important for the Physicians to link the two conditions and also specify laterality. Physicians must also link the conditions, document site and laterality.
Place of occurrence codes
The place in which the injury occurred, external causes of injuries, will be important in ICD-10. The is because the Place of occurrence codes (Y92) are extremely detailed, and physicians should provide as much information as possible. For example:
- Code Y92.126 denotes garden or yard of nursing home
- Code Y92.531 denotes healthcare provider office.
- Code Y92.250 denotes art gallery.
These codes could help in determining whether certain payers such as worker?s compensation, health insurance, car insurance, etc are liable for all or just a portion of the costs.
Lastly, physicians will have to be more specific in the patient encounter documentation with the increased number of codes and specificity under ICD-10.This will help in providing the coders to use the most correct codes for the most appropriate reimbursement.