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  • "Metallosis" and ICD-10

    Posted in Coding Blogs on Jul 13, 2017

    “Metallosis" is a condition occurring in Orthopedic Surgery which is the result of “Metal-On-Metal” (MOM) hip joint prostheses. To my knowledge there are no other Metal-On-Metal prostheses implanted in humans other than in the hip. In the thinking of Orthopedic Surgeons, this is not a “Metal Allergy,” but is more of a local and possibly systemic “Metal Toxicity” reaction. The local reaction around the prosthesis is basically an inflammatory Foreign Body Reaction to the micro-particles of metallic debris resulting from the metal femoral head rubbing and wearing against the metal acetabular s...

  • Knee Pain and ICD-10

    Posted in Coding Blogs on May 26, 2017

    Knee Pain and ICD-10 Knee Pain is very difficult to discuss in a Blog because there are so many potential causes of knee pain, a very common Chief Complaint of Orthopedic patients. The basic, generic code for "Knee Joint Pain" is M25.56 _. This code "implies" that the cause of the pain is from within the knee joint, which it may or may not be. There are numerous causes of knee pain from within the joint, Intra-articular , such as disorders of articular cartilage, synovium, menisci, ligaments, arthritic conditions from various causes, to name a few. However, there are many disorders that cause...

  • Fractures of the Lower Leg and Ankle

    Posted in Coding Blogs on Nov 09, 2016

    This Blog concerns itself with fractures involving the lower leg and ankle, which can be rather complicated and complex. It will not address fractures of the patella or proximal tibia and/or fibula, but starts with the shafts of these bones, then on distally to include the ankle. Also, it does not include the coding for Salter-Harris Fractures of the lower leg and ankle region. (See the Blog on Epiphyseal/Physeal Fractures.) As reminder, there are Defaults in the coding of fractures, which are that fractures are deemed to be closed unless clearly described as open, and are displaced unless...

  • Coding Epiphyseal/Physeal Fractures

    Posted in Coding Blogs on Nov 03, 2016

    Physeal/Epiphyseal Fractures are fractures of growing children, which can occur from birth all the way up to the full completion of growth, which in some locations can be in young adulthood (the epiphyses of clavicle in particular). The reason these fractures are so important is that they have the potential for disturbed/abnormal growth in the length of the bone over time, resulting in deformity of the bone itself and/or the adjacent joint. In general, the risk is probably the lowest for Salter-Harris Types I and II, but the risk gets higher with the more complicated and complex Types III an...

  • Wrist and Hand Pain: Is it Carpal Tunnel Syndrome?

    Posted in Coding Blogs on Oct 20, 2016

    The purpose of this Blog is to help sort out painful problems of the wrist and hand, particularly of a neurologic nature, as well as for painful situations that may not have a clearly identifiable underlying cause or diagnosis. Pain in the wrist, hand, and fingers is a very common Chief Complaint for patient's seeing an Orthopedic Surgeon. These patients often come in with a preconceived diagnosis of Carpal Tunnel Syndrome as told to them by their Primary Care person, which may or may not be true, and may or may not be supported by good clinical information and testing. There are hundreds o...

  • Coding Hip Fractures

    Posted in Coding Blogs on Oct 03, 2016

    Coding Hip Fractures As common as hip fractures are in adults, and rare in children, and in creating my book from the ICD-10 Coding Manuals, you would think that coding these would be a fairly simple and straightforward process. However, in reviewing Fractures of the Femur (S72) the way these are organized and presented in ICD-10, this is far more confusing and complicated than it should be. I am creating this Blog in an attempt to clarify this. The Authors/Creators of the American version of ICD-10 real made a mess of it. Rather than using the vernacular or common terminology of American...

  • Coding for Low Back Pain

    Posted in Coding Blogs on Sep 19, 2016

    Low Back Pain is one of the most common Chief Complaints and problems by patients presenting to physicians in general and to Orthopedic Surgeons in the practice of general orthopedics, right up there with knee pain and shoulder pain. For practical purposes, at some point in their life, most everybody suffers an episode of lower back pain. Much of the introduction to this Blog is spent discussing the anatomy of the lower back, and its complexities. This discussion may seem excessive to Coders, but it also helps explain why the exact diagnosis for the cause of the low back pain is so difficul...

  • Coding Updates for Orthopedic Surgery 2017

    Posted on Aug 26, 2016

    As Yogi Berra famously said: “It ain’t over til it’s over.” I guess the same can be said for ICD-10. From the perspective of an Orthopedic Surgeon, ICD-10 is full of flaws and faults, which are readily identifiable particularly when trying to interpret the coding manuals as they currently exist. That is why I created my book, ICD-10 for Orthopedic Surgery, as a way of translating the language of coding into a language that is more closely related to, and understood by Orthopedic Surgeons and their Coders. As most Coders are well aware by now, there are going to be some major coding changes...

  • Coding for Pain

    Posted in Coding Blogs on Aug 25, 2016

    Coding for Pain This is a discussion of coding for Pain from the perspective of Orthopedic Surgery. In orthopedics, the single most common patient complaint is “pain.” However, “pain” is a "symptom," not a "disease." Pain is the manifestation of an underlying disease or problem, i.e. the “Pain” is caused by something else. There are a variety of types of pain: acute, subacute, chronic, localized, regional, traumatic, degenerative, psychogenic, neurologic, limb, joint, etc. For musculoskeletal "pain,” it can come from any of the tissues that compose the Musculoskeletal System: bone, joint...

  • Coding of Upper and Mid-Back Pain

    Posted in Coding Blogs on Aug 16, 2016

    Coding of Upper and Mid-Back Pain Pain in the Upper and/or Mid-back is not as common as neck pain or low back pain, and the more common causes are somewhat different than these others areas as well. Most of the Upper Back Pain is seen in older adults, and results from mostly degenerative processes. Again, as in Neck Pain, this would be considered a Regional Pain for the thoracic spine. There are normally 12 thoracic vertebrae, with the spinal cord contained within the spinal canal, and 12 thoracic nerves on each side. The rib cage, attached to the thoracic spine, provides some support to t...

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