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ICD-10-CM For Orthopedics Lynn M. Anderanin, CPC, CPC-I, COSC, AHIMA ICD-10-CM Certified Trainer

ICD-10-CM For Orthopedics€¦ · ICD-10 will be made on October 1, 2011 On October 1, 2012 there will be only limited code updates to both ICD-9-CM & ICD-10 code sets to capture

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Text of ICD-10-CM For Orthopedics€¦ · ICD-10 will be made on October 1, 2011 On October 1, 2012 there...

  • ICD-10-CM For Orthopedics

    Lynn M. Anderanin, CPC, CPC-I, COSC, AHIMA ICD-10-CM Certified Trainer

  • Healthcare Information Services (HIS)

      HIS is a physician management company based in Chicago, IL specializing in Revenue Cycle Management and Information Technology.

      HIS provides services for over 450 providers and has a dedicated Division for Orthopaedics.

      HIS is dedicated to helping physicians maximize their reimbursement revenue, lower overhead and enhance your bottom line. HIS is an expert partner for increased profitability for your Orthopaedic practice.

  • Presenter - Lynn Anderanin   Lynn Anderanin, CPC,CPC-I,COSC is the Sr. Director Coding

    Compliance and Education for Healthcare Information Services (HIS). She has over 28 years experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Lynn’s experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology.

      She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, audio conferences, and Local Chapters.

      Lynn became a CPC in 1993, and a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in 2009. Lynn is the founder of the first local Chapter of the AAPC in Chicago, which is now 15 years old, and a former member of the AAPC National Advisory Board as well as other Boards for the AAPC.

  • ICD-10 is Coming  HHS hints at Delay ?   No date set or confirmation of a certain

    delay  5010  Meaningful Use

     Certain Healthcare Entities   Plan for the October 2013 timetable   Do not relax and rely on a lengthy delay

  • General Facts ICD–9–CM  diagnosis  codes     ICD–10–CM  diagnosis  codes  

    3–5  characters  in  length       3–7  characters  in  length.    

    Approximately  14,000  codes     Approximately  69,000  available  codes.    

    First  digit  may  be  alpha  (E  or  V)  or  numeric;  Digits  2–5  are  numeric      

    Digit  1  is  alpha;  Digits  2  and  3  are  numeric;  Digits  4–7  are  alpha  or  numeric  

    Limited  space  for  adding  new  codes       Flexible  for  adding  new  codes.    

    Lacks  detail       Very  specific.    

    Lacks  laterality       Has  laterality.    

    Difficult  to  analyze  data  due  to  non-‐specific  codes  Specificity  improves  coding  accuracy  and  richness  

    of  data  for  analysis.    

    Codes  are  non-‐specific  and  do  not  adequately  define  diagnoses  needed  for  medical  research  

    Detail  improves  the  accuracy  of  data  used  for  medical  research.    

    Does  not  support  interoperability  because  it  is  not  used  by  other  countries.  

    Supports  interoperability  and  the  exchange  of  health  data  between  other  countries  and  the  U.S.  

  • Quick References   Annual updates of each system are posted on the

    ICD-10 website at http://www.cms.gov/ICD10

      Maintenance and updates of ICD-9-CM and ICD-10 are discussed at the ICD-9-CM Coordination and Maintenance (C&M) Committee meeting


  • Draft ICD-10-CM

    Official Guidelines for Coding and Reporting


  • GEMS   General Equivalence Mappings (GEMs) assist in

    converting data from ICD-9-CM to ICD-10

      Forward and backward mappings

    Information on GEMs and their use –http://www.cms.gov/ICD10 (click on ICD-10-CM or ICD-10-PCS to find most recent GEMs)

      GEMs are not a substitute for learning how to code with ICD-10

  • Implementation Schedule   Last regular, annual updates to both ICD-9-CM and

    ICD-10 will be made on October 1, 2011

      On October 1, 2012 there will be only limited code updates to both ICD-9-CM & ICD-10 code sets to capture new technology and new diseases

      On October 1, 2013 there will be only limited code updates to ICD-10 code sets to capture new technology and new diseases

      On October 1, 2014 regular updates to ICD-10 will begin

  • Orthopedic Character Changes

      Right, Left, and Unspecified

      Initial Encounter, Subsequent Encounter, or Sequela

      Active Treatment or Aftercare

  • Other Notes   The letter U is not used in ICD-10-CM

      7th placeholder is always alpha

      The word “with” means includes, the word “and” means either or.

  • Initial, Subsequent, and Sequela for Injuries

    7th character utilized on most injuries with the exception of fractures

      A- Initial Encounter- patient receiving active treatment for an injury

      D-Subsequent encounter- patient is receiving routine care during healing or recovery phase

      S-Sequela-patient is being seen for complications or conditions as a direct result of an injury

  • Placeholder “x”   Used in the 4th, 5th, or 6th character position

      Utilized when a 6th or 7th character position is necessary


      M86.8x1-Other osteomyelitis, shoulder   SØ6.5xØA-Initial encounter for traumatic subdural

    hemorrhage without loss of consciousness   X75.xxxS-Intentional self-harm by explosive material,


  • NEC and NOS   NEC

      Not elsewhere classified   Not elsewhere classifiable  NEC leads you to certain specified forms are

    classified elsewhere

      NOS   Not otherwise specified

  • Excludes   Two kinds of excludes notes

      Note 1- NOT CODED HERE (ICD-9)- Two codes cannot be coded together   Congenital vs. acquired

      Note 2- Not included here- Indicates that codes listed could be billed together only if appropriate, but they may be needed to reported for clarification

  • Chapter 12 Diseases of the Skin and Subcutaneous Tissue

      L00-L08- Infections of the skin and subcutaneous tissue

      L60-L75- Disorders of skin appendages   L76- Intraoperative and postprocedural

    complications of skin and subcutaneous tissue

      L80-L89- Other disorders of the skin an subcutaneous tissue   L89-Pressure ulcer

  • Chapter 13 Diseases of Musculoskeletal and connective tissue (M00-M99)

      Site and laterality

      Bone Versus Joint

      Acute Traumatic vs. chronic recurrent

      Pathological Fractures


  • Site and Laterality Most codes in Chapter 13 have site and laterality designations.

      Site represents   Bone   Joint   Muscle   Multiple sites code   If there is no multiple site code, multiple codes

    should be used

  • Bone Vs. Joint

      Bone maybe affected at upper or lower end

      If joint is affected as well as bone, the designation will be the bone, not the joint

  • Acute Vs. Chronic or Recurrent

    Many musculoskeletal conditions result of previous injury or trauma to a site, or are recurrent conditions.

      Chapter 13 has   Chronic or recurrent bone, joint, or muscle conditions   Conditions that are the result of healed injury   If it is difficult to determine acute or chronic, query

    the provider

     Acute injury coding is in Chapter 19

  • Swelling of a Limb No longer a code for swelling of a limb

      Now classified to other soft tissue disorder NEC   See Disorder, soft tissue, specified type, NEC

    ICD-9-CM- 729.81 Swelling of limb

    ICD-10-CM- M79.8 Other specified soft tissue disorder

  • Pathological Fractures   7th character treatment status


      M80-with current pathological fracture

      M81-without pathological fracture

  • Osteoarthritis

    M15-19  Codes to 5th and 6th character

      Listed by body part   Unilateral and bilateral   Right and left   Primary and secondary

  • Other Joint Disorders M20-25   M20-Acquired deformities of fingers   M21-Other acquired deformities of limbs   M22-Disorder of patella   M23-Internal derangement of knee   M24-Other specific joint derangements   M25-Other joint disorder, not elsewhere classified

  • Deforming Dorsopathies M40-49   M40-Kyphosis and lordosis


      M42-Spinal osteochondrosis

      M43-Other deforming dorsopathies

      M45-Ankylosing spondylitis

      M46-Other inflammatory Spondylopathies


      M48-Other spondylopathies

      M49-Spondylopathies in diseases classified elsewhere

  • Other Dorsopathies

    M50-M54   M50-Cervical disc disorders

      M51-Thoracic, thoracolumbar, and lumbosacralintervertebral disc disorders

      M53-Other and unspecified dorsopathies, not elsewhere classified


  • Soft Tissue Disorders   M60-M63-Disorders of muscles

      M65-M67-Disorders of synovium and tendon

      M70-M79-Other soft tissue disorders

      M80-M85-Disorders of bone density and structure


      M96-Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified

  • Chapter 17 Now titled Congenitial Malformations, Deformations, and Chromosomal, Abnormalities

      Q00-Q07- Nervous system

      Q65-Q79- Musculoskeletal system

      Q80-89- Other congenital malformations

      Q90-Q99- Chromosomal abnormalities, not elsewhere classified

  • Chapter 19 Injury, Poisoning, and other certain consequences of external causes (S00-T88)

      Traumatic Injury- SØØ-T14.9   Code the most serious injury first

      Complications of care   Pain due to medical devices- T code section

      Aftercare Z codes should not be used for aftercare for injuries

  • Injuries ICD-9-CM to ICD-10-CM


    Codes looked up by type and then site


    Codes looked up by body region and then type

  • Injuries   SØØ-SØ9-head



      S3Ø-S39-abdomen,lower back, lumbar spine, pelvis

      S4Ø-S49-shoulder and upper arm

      S5Ø-S59-elbow and forearm

      S6Ø-S69-wrist and hand

      S7Ø-S79-hip and thigh

      S8Ø-S89-knee and lower leg

      S9Ø-S99-ankle and foot

  • Fractures   Displaced or non-displaced

      Fracture type (2,3,or 4 part)

      What kind (greenstick, communited, transverse)

      Routine healing, delayed healing, malunion,nonunion

      Open or closed   Open breaks down further (Type I, II,IIIA,IIIB,IIIC)

  • Open Fractures Gustilo Open Fracture Classifications

      3 main categories, I,II,III

      Type III further divided, IIIA,IIIB,IIIC   Mechanism of injury   Extent of soft tissue damage   Degree of bone injury or involvement

  • Salter-Harris Fractures Occur along the epiphyseal (growth) plates

      Listed under fracture, then physeal

      Classified into 9 types   Types I-IV- most common

      Specific codes for most site   Types V-IX- less common

      Other physeal fracture

      If no type is specified, use unspecified code

  • Fracture 7th character extension for type of encounter

      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

  • Right, Left and Unspecified 6th character utilized to designate side

    Fracture of pisiform

      S62.161-Displaced fracture, right wrist   S62.162-Displaced fracture, left wrist

      S62.163-Displaced fracture, unspecified wrist

      S62.164-Nondisplaced fracture, right wrist

      S62.165-Nondisplaced fracture, left wrist   S62.166-Nondisplaced fracture, unspecified wrist

  • Chapter 20 External Causes of Morbidity Replaces E Codes


      VØØ-V99-Transport accidents

      WØØ-X58-Other external causes of accidental injury

      WØØ-W19-Slipping,tripping,stumbling,and falls


  • Chapter 20 Notes Y85-89- Sequelae of External Causes of Morbidity and Morality

      All late effects for each intent brought together in a subchapter

      Alpha Extender for sequelae “S” is added to the code   Y89-Sequelae of other external causes   W55.01S-Bitten by cat, sequela

  • Chapter 21 Factors influencing health status and contact with health services

    Replaces V Codes

      Z68- Body mass index

      Z80-Z92- History of

      Z96- Presence of other functional implants

  • Aftercare Encounter for:

      Z45- Adjustment and management of implanted device

      Z47- Orthopedic aftercare

      Z48- Other postprocedural aftercare

  • References for this Presentation


      ICD-10-CM-The Complete Official Draft Code Set- DRAFT

      Implementing ICD-10


      Advanced Anatomy and Physiology for ICD-10-CM/PCS

  • Improve Profitability with HIS

      HIS is a full service Physician Management organization offering expert services in Revenue Cycle Management, EHR, Consulting and IT services.

      Expert Coding consultation, Coding Certification (including ICD-10), training, audits, assessments, etc.

      HIS typically can increase your reimbursements by 10% or more.   Call HIS to see how we can improve your reimbursements,

    lower overhead and boost overall profitability. 1-855-RING-HIS

  • RCM plus EHR   HIS is the only reseller in the nation of the award

    winning productivity-driven SRS-EHR by SRSsoft.

      More Orthopedics are using SRS than any other EHR in the country!

      Bundled service: SRS-EHR and HIS's Revenue Cycle Management Services together   Mitigates the up-front costs associated with the software,

    hardware and implementation of an EHR purchase.

      HIS will amortize the hardware and software costs into HIS’ monthly service fee... allowing you to enjoy the benefits and costs savings with zero capital out-lay.

  • Contact HIS   Andy Salmen

      Business Development   847-720-7007   [email protected]

      Lynn Anderanin   Senior Director of Coding Education and Compliance   847-720-7090   [email protected]