3 Things Orthopedic Coders Need to Know About ICD-10 2017

Fri, Aug 19, 2016 --

Coding Updates, ICD-10

cervical spine orthopedic ICD10 2017

Orthopedic coders: If you claim that you get hit particularly hard by ICD-10, you may have a point!

When ICD-10 introduced nearly 200 codes to replace 714.0 (Rheumatoid arthritis) in 2015, you earned the right to take a breather before moving on to learning the seven different seventh character options that may apply to fractures.

And now it’s time to prepare for the changes coming to orthopedic diagnoses in the ICD-10-CM 2017 code set, which will go into effect Oct. 1, 2016. You can start your prep work with these three helpful hints.

1. Nail Down Atypical Femoral Fracture Terminology

New subcategory M84.75- (Atypical femoral fracture) has people asking what exactly an atypical fracture is. The ICD-10 Tabular doesn’t offer much help as there are no instructional notes listed with the subcategory other than the list of seventh character options to use.

But, as the Orthopedic Coding Alert reports, the March 2012 Summary of Diagnosis Presentations from the Coordination and Maintenance Committee provides a clue about what these orthopedic ICD-10 codes refer to.

The Summary reveals that “atypical fracture” is a term that’s common in academic settings, but it may be less common outside of academics. You may see these types of femur fractures referred to as Fosamax fractures, but they can occur in patients who haven’t taken bisphosphonates. The radiology report may help in identifying these fractures as they have characteristic radiographic findings such as thickened cortices (outer layers).

2. Demand Cervical Disc in Documentation

If you code for cervical disc disorders, don’t miss the change from codes that lumped “mid-cervical region” codes together. Under ICD-10 2017, you’ll need to know whether the condition affects C4-C5, C5-C6, or C6-C7 (check your M50.-2- codes for 2017).

Example: ICD-10 2016 code M50.22 (Other cervical disc displacement, mid-cervical region) will expand in ICD-10 2017 to these four codes:

  • M50.220, Other cervical disc displacement, mid-cervical region, unspecified level
  • M50.221, Other cervical disc displacement at C4-C5 level
  • M50.222, Other cervical disc displacement at C5-C6 level
  • M50.223, Other cervical disc displacement at C6-C7 level.

3. Remember to Look Beyond the Codes

Code additions get a lot of attention, but they aren’t the only changes that can affect your coding accuracy and documentation needs. You have to review additions, revisions, and deletions to the Tabular notes and Index, too.

You may find a note that gives you confidence you’re using the correct code for a diagnosis, such as the addition of “compression fracture of vertebra NOS” with M48.5- (Collapsed vertebra, not elsewhere classified).

Or you may discover code changes you might have missed otherwise, like the change in the seventh character requirements for S99.- (Other and unspecified injuries of ankle and foot). Instead of using A (initial), D (subsequent), and S (sequela) for each code in that category, check the subcategory’s requirements.

Example: A note with new subcategory S99.0- (Physeal fracture of calcaneus) lists these seventh character options:

  • A, Initial encounter for closed fracture
  • B, Initial encounter for open 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.

What About You?

Are you feeling frustrated by ICD-10 changes, or are you seeing some new options that you think will be helpful?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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4 Comments For This Post

  1. chrisitine Taxin Says:

    are there new ICD codes for an orthotic for the oral cavity for TMD

  2. Deborah Marsh Says:

    Hi – There are updates for 2017 related to TMD diagnoses. These codes may help show medical necessity when reporting the supply of the orthotic, but these codes don’t represent the orthotic itself. ICD-10 2016 codes M26.60 to M26.63 will expand to require a sixth character in 2017 that indicates right (1), left (2), bilateral (3), or unspecified side (9). For example, M26.622 is defined as “Arthralgia of left temporomandibular joint.” Hope that helps!

  3. Annette Thompson Says:

    Are these changes for all states ? I am in Louisville, Kentucky

  4. Deborah Marsh Says:

    Hi, Annette:
    Yes, these changes apply for all states for use with payers who require ICD-10 codes – all HIPAA-covered entities at a minimum. According to this document from CMS – https://www.cms.gov/medicare/coding/icd10/downloads/icd-10mythsandfacts.pdf – other payers like workers comp and auto insurance are encouraged to adopt them, too, but it’s a good idea to check on which code set the payer requires. Thanks for the question!

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