ICD-10 for Orthopaedics
ICD-10 for orthopedics includes the most number of codes, however, orthopedics concepts such as laterality (left, right) type of fracture, the severity of the fracture, issues such as how the fracture is healing are now spread across all bones of the human body. Therefore while there are many more codes, there are a few key concepts that can help orthopedic specialists ensure that their documentation supports ICD-10.
Under ICD-10 CM diagnosis codes, there are 300 codes pertaining to fractures, such as the ankle, arm, elbow, femur, forearm, finger, foot, hand, head, hip, humerus, knee, leg, lower back, lumbar spine, neck, pelvis, rib, shoulder, skull/facial bones, thorax, thumb, toe, tooth, upper arm, vertebra, wrist.
It is not always true that ICD-10 requires more data and information (specificity) than ICD-9.
Not all ICD-10 Codes Require More Specificity than ICD-9.
For example, fractures of the skull coded in ICD-9 contain considerably more detail per code than similar codes in ICD-10.
ICD-9 Example:
- 80024 (ICD-9) – Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness and return to a pre-existing conscious level
ICD-10 Example:
- S020XXA (ICD-10) – Fracture of vault of skull, initial encounter for closed fracture[1]
Laterality and ICD-10
While it is generally believed that ICD-10 will require greater coding specificity, there are still many unspecified codes that providers could use within the selection of more specified codes.
Example: While ICD-10 provides the specificity of laterality, the coder could elect to not specify the side of the body for these orthopedic conditions [2]
- S52101A – Unspecified fracture of upper end of right radius, initial encounter for closed fracture
- S52102A – Unspecified fracture of upper end of left radius, initial encounter for closed fracture
- S52109A – Unspecified fracture of upper end of unspecified radius, initial encounter for closed fracture
Fracture Documentation
When documenting fractures, include the following parameters: [3]
- Type – e.g. Open, closed, pathological, neoplastic disease, stress e.g. Comminuted, oblique, segmental, spiral, transverse
- Pattern – e.g. Comminuted, oblique, segmental, spiral, transverse
- Etiology to document in the external cause codes – e.g. Normal healing, delayed healing, nonunion, malunion e.g. Shaft, head, neck, distal, proximal, styloid
- The encounter of care – e.g. Normal healing, delayed healing, nonunion, malunion e.g. Shaft, head, neck, distal, proximal, styloid
- Healing status, if subsequent encounter – e.g. Normal healing, delayed healing, nonunion, malunion
- Localization – e.g. Shaft, head, neck, distal, proximal, styloid
- Displacement – e.g. Displaced, non displaced
- Classification – e.g. Gustilo-Anderson, Salter-Harris
- Any complications, whether acute or delayed – e.g. Direct result of trauma sustained
In addition, depending on the circumstances, it may be necessary to document intra-articular or extra-articular involvement. For certain conditions, the bone may be affected at the proximal or distal end. Though the portion of the bone affected may be at the joint at either end, the site designation will be the bone, not the joint. [4]
Related Topics
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Medical Billing Expert Witness
[1] [2] Nichols, J. CD-10: Specified or Unspecified?
[3],[4] CMS.gov. Clinical Concepts for Orthopedics
