Orthopedic Coding Alert
New Diagnosis Codes Eliminate Ambiguity When You Report Prosthesis Complications
The 2006 crop of ICD-9 codes will help describe family histories, problems with prosthetics If you've been waiting for a better way to describe the causes of your patients' prosthetic joint implant problems, help is finally on the way with several new diagnosis codes, which take effect on Oct. 1. Assign Complication Codes Based on Problem Orthopedic practices will benefit from nine new prosthesis or implant complication diagnosis codes: Deletion alert: ICD-9 will delete the unspecific code 996.4 (Mechanical complication of internal orthopedic device, implant, and graft) to make room for the more detailed codes. "Code 996.4 has been expanded to five digits, so we will now be able to report the specific mechanical complication of the orthopedic implant or device," says Leslie Follebout, CPC, coding department supervisor at Peninsula Orthopaedic Associates PA in Salisbury, Md. "I'm glad that some specific codes will be available for problems with previously placed orthopedic hardware," says Denise Paige, CPC, coding/billing manager at Beach Orthopedic Associates in Long Beach, Calif., and president of the AAPC's Long Beach Chapter. 2 Examples Show You the Way Example 1: You might use 996.43 if the actual prosthesis device broke, Follebout says, or if a locking ring on a total hip replacement broke. New 'V' Codes Debut The new version of ICD-9 will delete the general code V17.8 (Family history of certain chronic disabling diseases; other musculoskeletal diseases) and will replace it with the following four-digit codes: The new crop of diagnosis codes also includes 278.02 (Overweight). "I assume you would use that on a patient who could not actually be called obese yet," Follebout says. "Medical texts define obesity as a patient who is from 20 to 30 percent over the average weight for his or her age, sex and height."
The Centers for Disease Control and Prevention and CMS unveiled their new 2006 ICD-9 codes, and because payers do not allow a grace period for the new codes, you need to get acquainted with the newbies and update your superbills by Sept. 30.
Coders hope that the new codes will help paint a clearer picture for payers, so they can decrease their chances of having to resubmit claims, face requests for more information, or appeal denials.
Previous Codes Lacked Specificity
"Right now there are only a few codes to indicate a problem (996.4, 996.67, 996.77 and 996.78)," Paige says, "which are used a lot, but aren't very specific."
Example 2: Code 996.45 would apply if the patient had osteolysis due to a prosthetic complication. "As the prosthesis begins to wear out, little pieces of the plastic liner will come off and be absorbed into the hip joint," Follebout says.
"Osteolysis is the body's reaction to the presence of the microscopic pieces of plastic," Follebout says. "As the body absorbs the plastic, it also begins to absorb the bone, and the bone gets thinner."
When patients come back to the practice for x-rays status-post joint replacement surgery, although they may be asymptomatic, the physician will determine whether they suffer from bone that is so thin around the prosthesis that they are at risk of fracture. If so, you should report code 996.45.
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