Be Agile When Coding Conditions That Might Require PT
One code in ICD-10-CM may be useful to describe several different conditions. If you see patients with musculoskeletal issues, you may be collaborating with other providers, like other physicians, physical therapists (PTs), or occupational therapists (OTs). Although the diagnosis code(s) and coding conventions are standardized, and thus the same for everyone, sometimes the lay terms may vary. Here’s a couple rules of thumb when coding common conditions, and their respective diagnosis codes, that may send a patient between their physician’s office and a PT or OT. Be Familiar With Other Names Some conditions, like tendinopathy, aren’t listed in the ICD-10-CM books or guidelines. The condition itself is represented — but by a different name — so you need to be agile as you navigate the code book. Here are two common ankle conditions that need special attention to find in ICD-10-CM: Achilles tendinopathy, which is not listed in ICD-10-CM, can be coded using: Similarly, if the patient is experiencing tendinosis of an ankle, you’ll need to look elsewhere, because “tendinosis” isn’t listed in ICD-10-CM. Try these options instead: Another condition that PTs may treat is posterior tibial tendon dysfunction (PTTD), but, again, this condition isn’t listed in ICD-10-CM. Instead, you should look for posterior tibial tendinitis, which leads you to these codes: Note that some of these codes may overlap, in that a single code may be the best choice for multiple or different conditions. For example, M76.89 may be used for either tendinosis of ankle or PTTD, according to the American Physical Therapy Association (APTA). Remember: Even though some of these code descriptors feature language like “other specified,” they may indeed be the most specific code for the patient’s condition. Always code from the physician’s documentation, and query the physician if the information recorded is insufficient to select a code with confidence of accuracy. Pay Special Attention to 7th Character Many musculoskeletal conditions and injuries that require care collaboration between a physician and a PT or OT may have diagnosis codes that require a 7th character that shows the state of the condition, and not always the sequence of the encounter. For example, in the ICD-10-CM Official Guidelines for Coding and Reporting, the guidelines for Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99), explain how to use the 7th characters A and D to show whether the care a patient is receiving for a musculoskeletal condition is receiving active treatment or aftercare. For example, when coding fractures, you’ll use the 7th character to show the phase of treatment. The guidelines say: “7th character A is for use as long as the patient is receiving active treatment for the fracture. While the patient may be seen by a new or different provider over the course of treatment for a pathological fracture, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.” The guidelines say that as long as aftercare treatment for fractures is routine, you’ll use 7th character D: “7th character D is to be used for encounters after the patient has completed active treatment for the fracture and is receiving routine care for the fracture during the healing or recovery phase. The other 7th characters, listed under each subcategory in the Tabular List, are to be used for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae.” However, if surgery was involved and complications arose, you’ll need to make sure you find the appropriate code for the specific complication, and not only through sequelae. When reporting codes from Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88), excepting fractures, the 7th character values refer to the sequence of encounter. The guidelines say: “Most categories in this chapter have three 7th character values (with the exception of fractures): A, initial encounter, D, subsequent encounter and S, sequela. Categories for traumatic fractures have additional 7th character values. While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.” In many situations requiring collaborative care between physicians and PTs or OTs, this means that the encounter with a physician may utilize 7th character A, while PTs who see patients may use D or S when reporting encounters. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
