What ICD-10 Changes are Coming for Orthopedics?

Are you overwhelmed by ICD-10 changes that will affect your orthopedic practice? Stop. Take a deep breath. Know that everything will be ok. We’ve all survived change, and the transition to ICD-10 will be no different.

Although ICD-10 includes a whole slew of changes for the orthopedic specialty, physicians shouldn’t assume that compliance will be impossible. Tackling the changes head on—and bit by bit—will make the transition much easier.

John F. Burns, CPMA, CPC, CPC-I, CEMC, senior consultant with Doctors Management in Knoxville, TN and an AHIMA-approved ICD-10 Ambassador and ICD-10-CM/PCS trainer suggests several topics on which orthopedists should focus their attention.

Site specificity
Site specificity is a common theme in ICD-10, and many of the orthopedic diagnoses will require this information. Consider the following:

• 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
Many of the ICD-10 changes for the orthopedic specialty pertain to laterality—that is, specifying right, left, or bilateral. ICD-9 codes did not capture this information previously. For example, in ICD-10, physicians must specify laterality for osteoarthritis and joint disorders (M15-M25). Documentation of fractures must also specify right vs. left vs. bilateral. Arthopathies and polyarthropathies (M00-M14) also require documentation of laterality.

Type of encounter
When documenting fracture care, orthopedists must provide sufficient information so that coders can glean whether the encounter is initial (i.e., initial ER visit or any surgical care or follow up within the global period), subsequent (i.e., follow-up care rendered after the global period), or sequela (i.e., a residual effect after the normal healing period). This information is reported via the 7^th character in the ICD-10 fracture care code. For subsequent encounters, physicians must specify routine healing, delayed healing, malunion, or nonunion. For example, ICD-10 code M84.462G denotes pathological fracture, left tibia, subsequent encounter for fracture with delayed healing.

Combination codes
Although the orthopedic specialty includes few combination codes in ICD-10, physicians should at least be aware of them. For example, ICD-10 code M54.4- denotes lumbago with sciatica. Physicians must link the two conditions and also specify laterality. ICD-10 code M05.1- denotes rheumatoid lung disease with rheumatoid arthritis. Physicians must also link the conditions and document site and laterality.

Place of occurrence codes
Documenting any external causes of injuries, including the place in which the injury occurred, will be important in ICD-10 because it will help paint a more detailed picture for payers. 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 determine whether certain payers (e.g., worker’s compensation, health insurance, car insurance, etc.) are liable for all or a portion of the costs.

For more tools and resources on ICD-10, visit the Kareo ICD-10 Resource Center.