Coding Updates for Orthopedic Surgery 2017 | Blog

Coding Updates for Orthopedic Surgery 2017

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 and updates for 2017. The list of recommended Additions, Deletions, Revisions, etc. of all the codes in ICD-10 is roughly 1900, more or less, in number. This is not a Coding Blog in the same sense as the other Blogs I have created to help Coders with the correct codes. This is a Coding Update Blog based on my review of the list of recommended code changes for 2017 and as this list applies to Orthopedic Surgery, and “translated" into words and terms that Orthopedic Surgeons and Coders will understand. Interestingly, this list of recommended code changes will not be reviewed by the CMS until September, 2016, but, and this is a big “but,” if adopted and approved, will take effect in October 2016. So, the “Grace Period” for coding in 2016 will not only be over on October 1 of 2016, and everything coded after October 1st will require all of these coding changes/updates to be used as well. It is my belief that the CMS will pretty much "rubber stamp” approve these changes without hesitation. I seriously doubt that they are going to take each of these 1900 recommended changes and debate each of them one at a time. I have reviewed this entire list carefully, and extracted from it those coding changes that I think are pertinent to orthopedics. The entire list seems to isolate itself to those codes in the Tabular List of Diseases and Injuries, Chapter 8 of my book. In my book, I have designated these as Subchapters, so as I go through these code changes, I will do so for each Subchapter as warranted. Some of my Subchapters do not have any changes that I can identify, so these will not be included

Subchapter G: Diseases of the Nervous System (G00-G99):

  • G56: Mononeuropathies of the upper limb, 5 new codes have been added:
    • G56.03: Carpal Tunnel Syndrome, bilateral upper limb
    • G56.13: Other lesion of the Median nerve, bilateral upper limb
    • G56.23: Lesion of Ulnar nerve, bilateral upper limb
    • G56.33: Lesion of the Radial nerve, bilateral upper extremity
    • G56.43: Causalgia, bilateral upper limb
    • G56.83: Other Specified Mononeuropathy, bilateral upper limb
  • G:57: Mononeuropathies of the lower limb, 9 new codes have been added:
    • G57.03: Lesion of the Sciatic Nerve, bilateral lower limb
    • G57.13: Meralgia Paresthetica, bilateral lower limb
    • G57.23: Lesion of Femoral nerve, bilateral lower limb
    • G57.33: Lesion of Lateral Popliteal nerve, bilateral lower limb
    • G57.43: Lesion of Medial Popliteal nerve, bilateral lower limb
    • G57.53: Tarsal Tunnel Syndrome, bilateral lower limb
    • G57.63: Lesion of the Plantar Nerve, bilateral lower limb
    • G57.73: Causalgia, bilateral lower limb
    • G57.83: Other Specified Mononeuropathy, bilateral lower limb
  • G61: Inflammatory polyneuropathy, 1 new code added under G61.8, add
    • G61.82: Multifocal Motor Neuropathy
  • G97: Intra-operative and post-procedural complications and disorders of the nervous system, not elsewhere classified: I have revised Code Set G97.5 as below to read, and a new Code Set G97.6 has been added:
    • G97.5: Post-procedural hemorrhage of a nervous system organ or structure following a procedure
      • G97.51: Post-procedural hemorrhage of a nervous system organ or structure following a nervous system procedure
      • G97.52: Post-procedural hemorrhage of the nervous system organ or structure following a other procedure
    • G97.6: Post-procedural hematoma of a nervous system organ or structure following a procedure
      • G97.61: Post-procedural hematoma of a nervous system organ or structure after a nervous system procedure
      • G97.62: Post-procedural hematoma of a nervous system organ or structure following other procedure In essence, the original codes included both hemorrhage and hematoma, but with these code revisions, they have been divided into a code set for hemorrhage, and another for hematoma.

Subchapter L: Diseases of the Skin and Subcutaneous Tissue (L00-L99)

  • L76: Intra-operative and post-procedural complications of skin and subcutaneous tissue has been revised, with L76.22 being revised, and a new code L76.32 has been added as follows:
    • L76.22: Post-procedural hemorrhage of skin and subcutaneous tissue following a non-dermatologic procedure (the words “and hematoma” have been deleted)
    • L76.32: Post-procedural hematoma of skin and subcutaneous tissue following a non-dermatologic procedure

Subchapter M: Diseases of the Musculoskeletal System and Connective Tissue (M00- M99)

  • M21.6 : Other acquired deformities of the foot, several new codes have been added:
    • M21.611: Bunion right foot
    • M21.612: Bunion left foot
    • M21.621: Bunionette right foot
    • M21.622: Bunionette left foot
    • For whatever reasons, codes for bilateral bunions or bunionettes were not added.
  • M25.5 : Pain in joint: An additional 5th Character group, 4 for hand joint(s) has been added, with the 6th Character for laterality being in the same as for the other 5th Character groups. For example, M25.541 would be for joint(s) pain in the right hand, and M25.542 for the left hand joint(s).

M50: Cervical disc disorders

  • M50.02: Cervical disc disorder with myelopathy, Mid-cervical region: C4-C5, C5-C6, and C6-C7. I have revised this by adding the new and more specific 6 character codes:
    • M50.020: Cervical Disc Disorder with myelopathy, mid-cervical region, unspecified level
    • M50.021: C4-C5 level
    • M50.022: C5-C6 level
    • M50.023: C6-C7 level
  • M50.12: Cervical disc disorder with radiculopathy, Mid-cervical region. I have revised this by adding the new and more specific codes with 6 characters:
    • M50.120: Mid-cervical disc disorder, unspecified level
    • M50.121: C4-C5 level
    • M50.122: C5-C6 level
    • M50.123: C6-C7 level
  • M50.22: Other cervical disc displacement, Mid-cervical region, (which to me includes the disc terms ruptured, herniation, protrusion, and extrusion). I have revised this by adding the new and more specific codes with 6 characters:
    • M50.220: Other cervical disc displacement, mid-cervical region, unspecified level
    • M50.221: C4-C5 level
    • M50.222: C5-C6 level
    • M50.223: C6-C7 level
  • M50.32: Other cervical disc degeneration, Mid-cervical region. I have revised this to include the new and more specific 6 character codes:
    • M50.320: Other cervical disc degeneration, mid-cervical region, unspecified level
    • M50.321: C4-C5 level
    • M50.322: C5-C6 level
    • M50.323: C6-C7 level
  • M50.82: Other cervical disc disorders, Mid-cervical region I have revised these to add and include the new 6 character codes:
    • M50.820: Other cervical disc disorder, mid-cervical region, unspecified level
    • M50.821: C4-C5 level
    • M50.822: C5-C6 level
    • M50.823: C6-C7 level

      In attempting to provide the most specific code, as demanded by ICD-10, the Codes above with a 6th Character of “0,” being "unspecified level,” should not be used unless absolutely necessary.

  • M62: Other disorders of muscle, a new code has been added to M62.8: Other specified disorders of muscle, which is:
    • M62.84: Sarcopenia (which according to the dictionary means muscle wasting and weakness, and is a common cause of falls, particularly in the elderly and debilitated)
  • M84.75 : Atypical femoral fracture: This is an entirely new and additional Code Set to ICD-10. The only “Atypical fracture of the femur” that I can think of is one that is seen in patients who are taking Biphosphonate medications for the treatment of Osteoporosis. These medications, taken either orally or by injection, have the uncommon possibility of a spontaneous fracture of the upper femoral shaft. To my knowledge, none of these medications are exempt from this particular complication. Since this fracture does not fit with any of the other categories of long bone fractures, this whole Code Set has been developed and added to ICD-10 for use in the future. It is a 7 character code which has only the 7th Character possibilities of A, D, G, K, P, and S. The 6th Character describes the fracture pattern, the degree of completeness of the fracture, and laterality as described and defined in the list below.

    • 6th Character:
      • 1: Incomplete Atypical femoral fracture, right
      • 2: Incomplete Atypical femoral fracture, left
      • 4: Complete Transverse Atypical fracture of the femur, right
      • 5: Complete Transverse Atypical fracture the femur, left
      • 7: Complete Oblique Atypical fracture of the femur, right
      • 8: Complete Oblique Atypical fracture of the femur, left

      (The list of recommended code changes for 2017 includes a 6th Character of 0 for “unspecified" which I have chosen to exclude from my list as unspecified codes should not be used due to their lack of specificity.)

  • M96.83: Post-procedural hemorrhage and hematoma of a musculoskeletal structure following a procedure: This Code Set has been edited to separate and re-code hematoma and hemorrhage as complications of surgery. M96.830: Post-procedural hemorrhage of a musculoskeletal structure following a musculoskeletal procedure M96.831: Post-procedural hemorrhage of a musculoskeletal structure following an other, non-musculoskeletal system procedure M96.840: Post-procedural hematoma of a musculoskeletal skeletal structure following a musculoskeletal procedure (new, added code) M96.841: Post-procedural hematoma of a musculoskeletal structure after an other, non-musculoskeletal procedure (new, added code)

  • M97: Periprosthetic fractures: This is a new and additional Code Set for Periprosthetic fractures including hip, knee, ankle, shoulder, elbow, and “other” joint prostheses. The 5th Characters 1 and 2 designate laterality as usual. The 6th Character is X. These are 7 character codes with the only possible 7th Characters of A, D, or S.
    • M97.0 X : Periprosthetic fracture around an implanted hip joint prosthesis
    • M97.1 X : Periprosthetic fracture around an implanted knee joint prosthesis
    • M97.2 X : Periprosthetic fracture around an implanted ankle joint prosthesis
    • M97.3 X : Periprosthetic fracture around an implanted shoulder joint prosthesis
    • M97.4 X : Periprosthetic fracture around an implanted elbow prosthesis
    • M97.8XX _: Periprosthetic fracture around “other" implanted joint prosthesis See revisions to, and deletions of T84.0(4) below for Subchapter T.

Subchapter Q: Congenital Malformations, The formations, and Chromosomal Or abnormalities (Q00-Q99) There are changes in the Q66 Code Set for Congenital deformities of the feet, particularly as it relates to Q66.2 regarding metatarsus varus deformities. These will become 6 character codes with the 6th Character being 1: Right, 2: Left, and 3: Bilateral

  • Q66.2: Congenital Varus deformity of the foot
    • G66.21 _: Congenital Metatarsus Primus Varus of the foot (first metatarsal)
    • Q66.22 _: Congenital Metatarsus Adductus of the foot

Subchapter S: Injury, poisoning, and certain other consequences of external causes (S00-T88)

  • S54: Injury of the nerves at the forearm level: These codes have been revised in such a way that the 5th Character will become X, and the 6th Character will be for laterality, 1 or 2. The 7th Character possibilities remain the same as before, A, D, and S.
    • S54.0X : Injury to the ulnar nerve at the forearm level
    • S54.IX : Injury to the median nerve at the forearm level
    • S54.2X : Injury to the radial nerve at the forearm level
    • S54.3X : Injury of cutaneous sensory nerve at the forearm level
    • S54.8X : Injury of other nerves at the forearm level
  • S92.81 : Other fracture of the foot. This is a new, additional code requiring 7 characters. 6th Character: 1: Right, 2: Left 7th Character: A, B, D, G, K, P, and S.

  • S99: Other and specified injuries of the foot and ankle. This Code Set has several new and additional codes for epiphyseal (physeal) fractures of the calcaneus, metatarsals, and toes.
  • The 6th Character remains the same for laterality: 1: Right, 2: Left.
  • However, there has been a significant change in the 7th Characters for these fractures. Previously, the only possible 7th Characters were A, D, G, K, P, or S. Now the list of possible 7th Characters includes A, B, D, G, K, P, and S. This limits the possible “complications of healing” characters to G, K, and P. However, it must be noted that these particular 7th Characters apply only to the “complications of healing” of closed fractures.
  • Also, the B character for Initial Encounter for an Open Fracture of Grades I and II of the Gustilo classification has been added. This now allows for the coding of open epiphyseal fractures of the calcaneus, metatarsals, and toe phalanges only, which is not found elsewhere in ICD-10, where all epiphyseal fractures are considered to be closed, and the 7th Characters are limited to A, D, G, K, P or S. I have not seen anything else in the list of recommended coding changes for 2017 that allows for the coding of open epiphyseal fractures of the bones of the upper or lower extremities. However, I would expect that at some time in the future, the 7th Characters for open fractures will be extended to these other areas. However, the 7th Characters for “uncomplicated healing” and “complications of healing” of open fractures of Class I and II (E, H, M, and Q) are excluded from the list of possibilities. This does not make much sense to me in that if you can have an Initial Encounter for an open fracture, then you should also be able to code any healing, with or without complications, with the appropriate 7th Character for that same category of open fractures. Once an open fracture, always an open fracture. The way this is set up, although the Initial Evaluation and treatment may be for an open fracture (B), the subsequent care characters are limited to only those for closed fractures. If anybody can figure out why it was done this way, I would like an explanation.
  • Be that as it may, the following codes have been added to the S99 Code Set:

  • S99.0 _: Epiphyseal Fracture of the Calcaneus
    • S99.01 : Salter-Harris Type I epiphyseal fracture
    • S99.02 : Salter-Harris Type II epiphyseal fracture
    • S99.03 : Salter-Harris Type III epiphyseal fracture
    • S99.04 : Salter-Harris Type IV epiphyseal fracture
    • S99.09 : Other epiphyseal fracture
  • S99.1 _: Epiphyseal fracture of the Metatarsal
    • S99.11 : Salter-Harris Type I epiphyseal fracture
    • S99.12 : Salter-Harris Type II epiphyseal fracture
    • S99.13 : Salter-Harris Type III epiphyseal fracture
    • S99.14 : Salter-Harris Type IV epiphyseal fracture
    • S99.19 : Other epiphyseal fracture
  • S99.2 _: Epiphyseal fracture of the phalanx of the toe
    • S99.21 : Salter-Harris Type I epiphyseal fracture of phalanx of the toe
    • S99.22 : Salter-Harris Type II epiphyseal fracture
    • S99.23 : Salter-Harris Type III epiphyseal fracture
    • S99.24 : Salter-Harris Type IV epiphyseal fracture
    • S99.29 : Other epiphyseal fracture

Subchapter T: Poisoning, and certain other consequences of external causes (T00-T88)

  • T84.0: Mechanical complication of internal joint prosthesis has been revised and the code T84.04: Periprosthetic fracture around a joint prosthesis has been deleted, and replaced by the Code Set M97: Periprosthetic fractures as described above, and this would still probably Exclude breakage or fracture of a prosthetic complement (T84.01), which remains in place.

Subchapter V: Transport Accidents (V00-V99)

  • V47.0: Car driver injured in collision with fixed or stationary object, not in traffic accident has been revised with 47.01X and 47.02X being deleted and replaced with
    • V47.0XX _: Car driver injured in collision with fixed or stationary object, not in traffic accident 7th Character: A, D, or S
  • V47.1: Car passenger injured in a collision with fixed or stationary object, not in traffic accident has been revised with V47.11X and V47.12X being deleted and replaced with
    • V47.1XX _: Car passenger injured in collision with fixed or stationary object, not in traffic accident 7th Character: A, D, or S
  • V47.3: Unspecified car occupant injured in collision with fixed or stationary object, not in traffic accident has been revised with V47.31X and V47.32X being deleted and replaced with
    • V47.3XX: Unspecified car occupant injured in collision with fixed or stationary object, not in traffic accident 7th Character: A, D, or S Note: Insofar as this is an “unspecified” code, I would not use it unless absolutely necessary.
  • V47.5: Car driver injured in collision with fixed or stationary object, in traffic accident has been revised with V47.51X and V47.52X being deleted and replaced with
    • V47.5XX _: Car driver injured in collision with fixed or stationary object, not in traffic accident 7th Character: A, D, or S
  • V47.6: Car passenger injured in collision with fixed or stationary object, In traffic accident has been revised with V47.61X and V47.62X being deleted and replaced with
    • V47.6XX _: Car passenger injured in collision with fixed or stationary object, in traffic accident 7th Character: A, D, or S

Subchapter W: Other External Causes of Accidental Injury (W00-W95)

  • W26: Contact with knife, sword, or dagger: Two new codes have been added to this Code Set, essentially adding stiff paper (paper cut), and “Other” sharp object. 7th Characters: A, D, or S
    • W26.2XX _: Contact with edge of stiff paper (paper cut)
    • W26.8XX _: Contact with other sharp object, not elsewhere classified
  • W45: Foreign body or object entering through skin: Two codes in this category have been deleted: 7th Character: A, D, or S
    • W45.1XX _: Paper entering through skin (see changes to W26 above)
    • W45.2XX _: Lid of can entering through skin (see changes to W26 above)

Subchapter Z: Factors influencing health status and contact with health services (Z00-Z99)

  • Z53: Persons encountering health services for specific procedures and treatment, not carried out: A new code has been added to this Code Set as below
    • Z53.33: Arthroscopic surgical procedure converted to an open procedure
  • Z98: Other post-procedural states: 1 new code has been added to this Code Set as below
    • Z98.890: Other specified post-procedural state

Posted on Aug 26, 2016

Contact Dr. Pechacek