Orthopedic Coding Alert

Hint: These closed/open guidelines are the same — the displaced/nondisplaced guidelines are new.

You’re most likely making headway with your ICD-10 preparations. Check your answers with ours, and see how you fared.

Expand Your 715.xx Codes into Multiple Categories

Answer 1: C. You need to specify the anatomic location, status (primary, secondary, unspecified), and laterality.

All of your 715.xx codes will convert to codes from the Osteoarthritis section (M15-M19) of your ICD-10-CM manual. These categories are as follows:

• M15 (Polyosteoarthritis)
  
• M16 (Osteoarthritis of hip)
  
• M17 (Osteoarthritis of knee)
  
• M18 (Osteoarthritis of first carpometacarpal joint)
  
• M19 (Osteoarthritis of other joints).
  

What’s different: In ICD-9-CM, your osteoarthrosis codes (715.xx) specify the anatomical location (such as knee, hip, etc.) and status (primary, secondary, or unspecified).

In ICD-10-CM you will choose your code based on the following information:

1. the anatomical location (such as knee, hip, etc.)
2. status (primary, secondary, post-traumatic, or unspecified
3. whether the osteoarthrosis is right, left, or bilateral, or unspecified.

Note: The specific term “post-traumatic osteoarthritis status” is new, as in ICD-9, you would report this status as “traumatic arthropathy” with codes 716.11-716.19. As of October 1, 2014, ICD-10-CM more appropriately indexes this condition and describes it as post-traumatic osteoarthritis, the true condition.

However, you should note that “traumatic arthropathy” still exists in ICD-10 (M12.5---, Traumatic arthropathy …). Therefore, you need to know the difference between post traumatic osteoarthritis and traumatic arthropathy before deciding which diagnosis to report. Make sure your physician clearly documents this.

You do have unspecified codes, but you should always try to code to the highest level of specificity.

Go to the Highest Level of Specificity For Your Prosthetic Complication Code

Answer 2: C. You should report T84.03--, the last two characters depending on the anatomical location of the prosthetic joint, the laterality, and the encounter.

Code 996.41 (Mechanical loosening of prosthetic joint) crosswalks to T84.039A (Mechanical loosening of unspecified internal prosthetic joint, initial encounter), according to the GEM (General Equivalent Mappings). This mapping tool does not give you the full picture.

So if you stop there, you’re missing the more specific options. That is an “unspecified” code. You also have:

• T84.030A — Mechanical loosening of internal right hip prosthetic joint, initial encounter
  
• T84.030D — Mechanical loosening of internal right hip prosthetic joint, subsequent encounter
  
• T84.030S — Mechanical loosening of internal right hip prosthetic joint, sequela
  
• T84.031A — Mechanical loosening of internal left hip prosthetic joint, initial encounter
  
• T84.031D — Mechanical loosening of internal left hip prosthetic joint, subsequent encounter
• T84.031S — Mechanical loosening of internal left hip prosthetic joint, sequela
• T84.032A — Mechanical loosening of internal right knee prosthetic joint, initial encounter
• T84.032D — Mechanical loosening of internal right knee prosthetic joint, subsequent encounter
• T84.032S — Mechanical loosening of internal right knee prosthetic joint, sequela T84.033A — Mechanical loosening of internal left knee prosthetic joint, initial encounter
• T84.033D — Mechanical loosening of internal left knee prosthetic joint, subsequent encounter
• T84.033S — Mechanical loosening of internal left knee prosthetic joint, sequela
• T84.034A — Mechanical loosening of internal other prosthetic joint, initial encounter
• T84.034D — Mechanical loosening of internal other prosthetic joint, subsequent encounter
• T84.034A — Mechanical loosening of internal other prosthetic joint, sequela. 

Therefore, you need to check the physician’s documentation to determine the anatomic site of the prosthetic joint (hip, knee, other), the laterality (left, right, other), and the encounter (initial, subsequent, and sequela).

Make Sure You Apply These Guidelines To Your Fracture Codes

Answer 3: A) closed, displaced

As with ICD-9, when your provider does not document if the fracture was open or closed, you should report the fracture as closed. This follows over to ICD-10-CM guidelines.

However, unlike ICD-9, ICD-10 indicates you may report a fracture as displaced when the provider does not document the displacement.