Six Steps for ICD-10 Orthopedic Coding

Written by on May 3, 2012 in Features - No comments

Practices seeing patients with orthopedic conditions may have the toughest challenges, when it comes to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). The reason is that when you’re coding for ligament disorders, palmar fascia contracture, foreign body granulomas, and muscle spasm, your ICD-10 code choices will expand substantially. Follow these practical training steps to learn about how to handle — and when to not worry too much about — coding common connective tissue conditions.

Step 1: Get clinical staff used to be more specific

To prep doctors for this level of detail, start training now. “Before the ICD-10 implementation date, coders will need to educate their physicians on the need for a much higher degree of specificity in their diagnostic statements,” says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, N.J. and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, Cali.

Step 2: Identify discrete codes for paraplegia, fibromatoses

The International Classification of Diseases, Ninth Revision (ICD-9) codes for specific muscle disorders like 728.3 (other specific muscle disorders) which includes disorders like athrogryposis and immobility syndrome (paraplegic) translate to two different codes in ICD-10. The ICD-10 code for immobility syndrome is M62.3 (immobility syndrome [paraplegic]) and that for other specific disorders is M62.89 (other specified disorders of muscle). “Immobility syndrome has been awarded a specific code for ICD-10, while ‘other specified disorders of the muscle’ has been left undefined to capture the remainder of the unspecified muscle disorders,” says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington. The ICD-9 code for fibrosis in muscle ligaments, 728.79 (other fibromatoses of muscle ligament and fascia), extends to two ICD-10 codes as below:
• M72.1 (knuckle pads)
• M72.4 (pseudosarcomatous fibromatosis)

Step 3: Narrow down to a common code for ligament disorders

The ligament disorder code in ICD-10 is more generalized to include a wider array of ligament disorders. Whereas the ICD-9 code 728.4 (laxity of ligament) was solely descriptive of ligament laxity, the ICD-10 code category M24.2 – (disorder of ligament …) describes “disorder of ligament.” This implies that disorders other than a lax ligament can be reported with this code.

Remember: You need to identify the anatomic location where this condition occurs with the fifth and sixth digits.

Step 4: Determine scopes of “other” and “unspecified” muscle disorders

You’ll find a broader scope for M62.89 (other specified disorders of muscle). The disorder can be in muscle tendons, fascia, ligament, or aponeurosis. The ICD-9 code 728.89 (other disorders of muscle ligament and fascia), in contrast, is more specific for ligament and fascia. For the unspecified disorders of the connective tissues, you have code 728.9 (unspecified disorder of muscle ligament and fascia) in ICD-9. In ICD-10, you will opt for code M62.9 (disorder of muscle, unspecified). “ICD-10 has listed a code specific to the muscle alone. There is also a specific code for disorder of ligament. The ligamentous disorder code is broken down by location, right side (RT) versus left side (LT), with an unspecified code for each body area when RT and LT are not listed. Coders can now be more specific on the actual tissue affected,” says Stumpf.

Step 5: Get more specific for various other conditions

The ICD-10 code for Dupuytren’s contracture in the palm is more specific and inclusive of the condition. The ICD-9 code 728.6 (contracture of palmar fascia) includes Dupuytren’s contracture though the same does not appear in the descriptor. On the contrary, the ICD-10 code for the same is M72.0 (palmar fascial fibromatosis [Dupuytren]) which aptly specifies the condition in the descriptor. “M72.0 is very specific to palmar fibromatosis, whereas ICD-9 code 728.6 can be utilized for any contracture of the palmar fascia. Although ICD-9 code 728.6 is used for Dupuytren’s contracture, it would also apply to any other pathology resulting in palmar contracture,” says Stumpf. “Dupuytren’s contracture is by far the most common cause of palmar fibromatosis,” says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.
The ICD-9 code 728.82 (foreign body granuloma of muscle) for foreign body granuloma of muscle will become inclusive of foreign body granulomas in other soft tissues once ICD-10 rolls out. Code M60.20 (foreign body granuloma of soft tissue, not elsewhere classified, unspecified site) includes foreign body granulomas in soft tissues other than the muscles. For example, you will report subcutaneous tissue foreign body granulomas using the code M60.20.
You will find a single code for muscle spasm in ICD-9. The code 728.85 (spasm of muscle) includes a spasm of any type, including those due to injury and stroke, and due to conditions in which the brain or the spinal cord are destroyed, example cerebral palsy or multiple sclerosis. “In ICD-9, the default code for muscle contracture was 728.85, for lack of a more specific code choice,” says Stumpf. However, going further in once ICD-10 implementation date hits, you will have an option of two codes for such conditions. These include M62.40 (contracture of muscle, unspecified site) and M62.838 (other muscle spasm).

The catch: You’ll need to know the potential reversibility of the muscle contraction. If the muscle has contracted, become shortened, and fixes the limb permanently in one position, you would use code M62.40. However, if it is a contraction that has some potential of reversibility, you report code M62.838. “ICD-10 is supplying a very specific code for muscle contracture,” says Stumpf. “ICD-10 has supplied 24 codes from M62.40 through M62.49 to specify specific locations, RT versus LT, an unspecified code for each body location for use when RT/LT has not been clarified, and for ‘other site’ and ‘multiple sites’.”

Step 6: Don’t worry about other changes

Don’t worry, however. You’ll find other codes that do not reflect any change in descriptors in ICD-10. The descriptors for 728.5 (hypermobility syndrome) in ICD-9 and M35.7 (hypermobility syndrome) in ICD-10 are similar. The same is true of code 728.71 (plantar fascial fibromatosis) in ICD-9 and code M72.2 (plantar fascial fibromatosis) in ICD-10 for the fibrosis of the plantar fascia.
Another such example are the codes for necrotizing fasciitis in ICD-9, 728.86 (necrotizing fasciitis) and M72.6 (necrotizing fasciitis) in ICD-10 and for generalized muscle weakness in ICD-9, 728.87 (muscle weakness [generalized]), and M62.81 (muscle weakness [generalized]) in ICD-10. The codes for rhabdomyolysis in ICD-9 (728.88 [rhabdomyolysis]) and ICD-10 (M62.82 [rhabdomyolysis]) have common descriptors.
Another important condition that you may frequently report is the Ehlers-Danlos syndrome. “This commonly described condition may manifest as hypermobility and may present with ligamentous hyperlaxity,” says Mallon. You report code 756.83 (Ehlers-Danlos syndrome) for this specific condition. Once the ICD-10 implementation date rolls around, you shall report Q79.6 (Ehlers-Danlos syndrome).

Documentation warning: Don’t let “urosepsis” infect your ICD-10 claim with errors

If you don’t want queries, then strike this term from future notes.

If you document a patient note with the term “urosepsis,” you may find yourself having to clarify. You need to specify – is it a urinary tract infection (UTI) or a UTI with sepsis?

Currently: In ICD-9, your coding staff has coding conventions to follow, which is to use 599.0 (urinary tract infection, site not specified) for “urosepsis.” According to ICD-9 guidelines, “The term urosepsis is a nonspecific term. If that is the only term documented then only code 599.0 should be assigned based on the default for the term in the ICD-9-CM index, in addition to the code for the causal organism if known.”

In the future: However, ICD-10 eliminates this term. The ICD-10 manual includes a note to “code to condition,” which means he or she has to come back to you with a query to determine the appropriate code assignment.

Specifically, ICD-10 guidelines state:

(ii) Urosepsis: The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification.

Action item: Explain to your fellow physicians and coders “urosepsis” does not exist in ICD-10. That means physicians should not use that term, unless they want to be bothered with queries. More specific documentation about this condition is necessary. Start getting into the habit of documenting UTI or UTI with sepsis instead.



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