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  • Coding for Neck Pain

    Posted in Coding Blogs on Jul 25, 2016

    Coding for Neck Pain Neck pain (Cervicalgia), along with Back and Low Back Pain, Shoulder Pain, and Knee Pain, is a very common chief complaint for orthopedic patient’s. Neck pain is actually a “regional pain” in that it is pain located in the cervical/neck region. There are 7 cervical vertebrae with 8 cervical spinal cord segments and nerves. This region rests between the skull above (Occipito-Cervical Junction) and the seventh cervical and first thoracic vertebrae (C7-T1) below. Pain can originate from any of these “segments" and the "joints" between them, as well as all other tissues (mu...

  • Documentation and ICD-10

    Posted in Coding Blogs on May 25, 2016

    Documentation and ICD-10 "Documentation, Documentation, Documentation” is the “mantra” for ICD-10 that allows accurate coding. "Specificity, Specificity, Specificity” is the other “mantra” for ICD-10. After all the years of being hammered by documentation requirements, it would seem that physicians would have gotten the message. But, it is more likely that a leopard will change its spots than a physician will change his or her habits as it regards documentation. “I have been doing it this way for X/? number of years, why should I change now?” Why is this so important? The answer is simpl...

  • Shoulder Pain and ICD-10

    Posted in Coding Blogs on May 19, 2016

    Shoulder Pain and ICD-10 This is a very long Blog because shoulder pain in Orthopedics is very common, and a very complex and complicated diagnosis area to sort out. When people talk about shoulder pain, most everybody thinks that it is related to the shoulder joint only, but the shoulder region is a very complex portion of the human body, which can give rise to a multitude of causes for pain. From an anatomic standpoint, the “shoulder" includes three bony structures, three different joints, and numerous muscles, tendons, ligamentous structures, and bursa. The Shoulder Girdle is made up fro...

  • Tendon Ruptures, Traumatic or Spontaneous?

    Posted in Coding Blogs on May 17, 2016

    Tendon Ruptures, Traumatic or Spontaneous? I recently saw a coding newsletter about Achilles Tendon Ruptures in which the author stated that Achilles Tendon ruptures are “spontaneous,” not “traumatic.” Having treated this disorder many times over the 40 years in which I practiced, I disagree with her opinion. In this Blog, I am going to discuss Tendon Ruptures, both “spontaneous” (atraumatic/nontraumatic) and “traumatic.” The issue is what constitutes “trauma," which is a question of how much “stress” (load) the muscle-tendon unit is under at the moment of rupture. If there is no more st...

  • "Arthritis" and ICD-10

    Posted in Coding Blogs on Mar 25, 2016

    This Blog attempts to discuss Arthritis in such a way as to clarify and define some of the various types of arthritis, and how to approach it from the standpoint of a Coder, and from the perspective of Orthopedic Surgeon. In reviewing and participating in some online Forums, the issue of how to code for “Arthritis” appears frequently. Therefore, I am attempting to sort some of this out, and hopefully make it easier to approach as a Coder. I wish I could make this very “easy,” but it is not. "Arthritis" is literally "inflammation of the joint," but this definition is pretty vague and nonspec...

  • Coding Arthralgia verses Osteoarthritis

    Posted in Coding Blogs on Mar 23, 2016

    Sometimes there is a question as to the difference between “Arthralgia” and “Arthritis.” “Arthralgia” literally mean “Joint Pain” (Arth = Joint, and Algia = Pain), and can be fairly specific to a joint, or more vague such as to a region. Examples would be “My knee hurts.” as compared to “My leg aches around the knee region.” “Arthitis” literally means “Inflammation of a joint,” which indicates a true problem within the joint itself, and can be manifested by pain (“Arthralgia”). “Arthralgia” is more of a complaint or symptom than a disease or true diagnosis, and can be the manifestation of...

  • Coding Fractures of the Forearm and "Wrist"

    Posted in Coding Blogs on Mar 23, 2016

    Injuries to the forearm and wrist are common in Orthopedic Surgery, but the coding of these injuries in ICD-10, as compared to ICD-9, is different and more complicated. In ICD-9, fractures of the radius and ulna were in the 800._ codes for Injury and Poisoning. However, in ICD-10, these fractures are incorporated into the general category of "Injuries to the elbow and forearm" (S50-S59). The codes for fractures of the radius and ulna are in the S52 portion of this code set, and include the upper/proximal end, the shaft of, and the lower/distal end. In a CD-10, fracture codes for the "wrist...

  • Coding Articular Cartilage Defects

    Posted in Coding Blogs on Mar 23, 2016

    Articular Cartilage Defects can be found on the surface of many joints, particularly weight bearing joints such as the hip, knee, and ankle. They can be isolated findings, or part of more generalized joint surface disorder/disease (Chondromalacia). These can result acutely from a recent injury, or from more chronic situations. Also, when there is a defect, there may also be a Cartilaginous Loose Body in the joint. For the most part, the presence of a loose body in the joint of any size means that it had to come from someplace, i.e. from a cartilaginous defect. These can all be present in...

  • Coding Acute Acromioclavicular (AC) Joint Injuries:

    Posted in Coding Blogs on Mar 18, 2016

    Injuries to the Acromioclavicular (AC) Joint are very common shoulder region/joint injuries, most commonly resulting from falls, sports participation, vehicular accidents, etc. ICD-9 is of little to no help as a place to start when it comes to ICD-10 Coding, which is far more complicated and non-customary when applied to the “Traditional” thinking and grading by Orthopedic Surgeons. Anatomically, the AC Joint is the small joint at the lateral/distal end of the clavicle with the acromion process of the scapula/shoulder blade. It is located at the top and front of the shoulder. Females can lo...

  • Seventh Characters and the Gustilo Classification of Open Fractures

    Posted in Coding Blogs on Mar 18, 2016

    This is a discussion of Seventh Characters, their meaning, and how and when they are to be utilized because there is so much information involving their use. There are 3 general categories of Seventh Characters: Initial Encounters, Subsequent Encounters, and Sequelae. I have also defined the various types of open fractures as per the Gustilo Classification, and integrated these into the Seventh Characters for these Encounter Types. Initial Encounter: There are 3 different letters for use when initially evaluating and treating a patient: A, B, or C. These Seventh Characters begin with your i...

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