Orthopedic Coding Alert

Take note of the expanded option for fractures.

You have no real default seventh character default in orthopedics, so you need to be vigilant when you select your option. Give your ICD-10 orthopedic coding skills a workout with these example scenarios.

Read These Two Scenarios

Scenario 1: You will be providing IV antibiotics to treat your patient’s Staphylococcus aureus infection of her right hip joint prosthesis. How would you code for this patient?

Scenario 2: Your 70-year-old patient broke her right humerus at mid shaft (comminuted) in a go-kart accident when riding with her grandson. She had an open reduction internal fixation (ORIF) and the fixation device has come loose resulting in a nonunion of the fracture. She is immobilized until further surgery to repair. How should you code for this patient?

Check Your Answers Against The Expert’s

Scenario 1 answer: List the following codes for this patient, says Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10-CM Trainer/Ambassador of Selman-Holman & Associates, LLC, CoDR — Coding Done Right and Code Pro University in Denton, Texas:

• T84.51xA (Infection and inflammatory reaction due to internal right hip prosthesis)
• B95.61 (Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere).
• Z96.641 (Presence of right artificial hip join)

Because your patient is still receiving active care for her infected hip replacement, you’ll use seventh character “A” for initial encounter. Remember, seventh character “A” isn’t tied to the setting in which the care is provided, but to the condition for which the care is provided.

Follow this with B95.61 to indicate that your patient’s infection is caused by Staph aureus.

Scenario 2 answer: List the following codes for this patient, says Selman-Holman:

• T84.120A (Displacement of internal fixation device of right humerus, initial encounter)
• S42.351K (Displaced comminuted fracture of shaft of humerus, right arm; subsequent encounter for fracture with nonunion).

List the code for your patient’s complication first, Selman-Holman says. In this case, that means the displacement of the internal fixation device. Seventh character “D” is not appropriate because the situation is not healing/recovering, so you’ll list ‘A’ for this patient.

Follow this with a code to describe the condition resulting from the complication — nonunion of her fractured humerus. In this case, seventh character “K” indicates that you are providing subsequent care of a fracture with nonunion.