ICD10 CM Training Orthopaedic ICD10 CM Compliance Dates

ICD-10 CM Training Orthopaedic

ICD-10 -CM Compliance Dates • ICD-10 -CM will be valid for dates of service on or after October 1, 2015 – Outpatient dates of service of October 1, 2015 and beyond. – Inpatient hospital service claims, is effective for dates of discharge after September 30, 2015

Covered and Non-Covered Entities • Covered Entities – Everyone covered by the Health Insurance Portability Accountability Act (HIPPA) • Non-Covered Entities – Worker’s Compensation – Auto Insurance – Non covered HIPAA entities are exempt but are encouraged to adapt the new code set

ICD-10 Code Structure • 21 Chapters • Alpha-numeric codes; not case-sensitive – Codes begin with Alpha letter, A-Z, excluding U – Common errors • I verses 1 • O verses 0 • “X” Placeholder • 3 to 7 characters – Decimal following 3 rd character

ICD-10 Code Structure • Placeholder “X” – Used for future expansion of a code – Fills in empty characters when a 6 th and/or 7 th character apply – The placeholder may be used in different scenarios but should never serve as the final character. Example: W 19. XXXA Unspecified fall, Initial Encounter

ICD-10 Code Structure • 7 th Character – Provides specified information regarding the clinical visit – Is required for certain categories and must be reported in the seventh position – May be alpha or numeric – Has different meanings depending on the coding category

ICD-10 Code Structure • Laterality – Some ICD-10 -CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral. – If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. – If the side is not identified in the medical record, assign the code for the unspecified side. OGCR section 1. B. 13

ICD-10 Code Structure • “Other” Codes – Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist. • “Unspecified” Codes – Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. OGCR section 1. A. 9. a. b

ICD-10 Structure • Excludes Notes – Excludes 1 • • A type 1 Excludes note is a pure excludes note It means “NOT CODED HERE” The code excluded should never be used at the same time When two conditions cannot occur together – Excludes 2 • Represents “Not included here” • The condition excluded is not part of the condition represented by the code • It is acceptable to use both the code and the excluded code together, when appropriate OGCR section 1. A. 12. a. b

ICD-10 Code Structure • “Code First” and “Use Additional Code” – ICD-10 has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. – These instructional notes indicate the proper sequencing order of the codes. OGCR section 1. A. 13 • The “-” indicates there additional reporting options

Most Common Diagnosis Codes

Pain of Joint Category M 25. 5 Excludes 1 • • • Contracture of muscle without contracture of joint (M 62. 4 -) Contracture of tendon (sheath) without contracture of joint (M 62. 4 -) Dupuytren’s contracture (M 72. 0) Excludes 2 • acquired deformities of limbs (M 20 -M 21)

Pain, Shoulder Pain, Hip ICD-9 Code ICD-10 Code Description 719. 41 M 25. 511 Pain, right shoulder 719. 45 M 25. 551 Pain, right hip 719. 41 M 25. 512 Pain, left shoulder 719. 45 M 25. 552 Pain, left hip 719. 41 M 25. 519 Pain, unspecified shoulder 719. 45 M 25. 559 Pain, unspecified hip Pain, Elbow Pain, Knee ICD-9 Code ICD-10 Code Description 719. 42 M 25. 521 Pain, right elbow 719. 42 M 25. 522 Pain, left elbow 719. 42 M 25. 529 Pain, unspecified elbow Pain, Wrist ICD-9 Code ICD-10 Code Description 719. 43 M 25. 531 Pain, right wrist 719. 43 M 25. 532 Pain, left wrist 719. 43 M 25. 539 Pain, unspecified wrist ICD-9 Code ICD-10 Code Description 719. 46 M 25. 561 Pain, right knee 719. 46 M 25. 562 Pain, left knee 719. 46 M 25. 569 Pain, unspecified knee

Pain, Ankle and Foot ICD-9 Code ICD-10 Code Description 719. 47 M 25. 571 Pain, right ankle and foot 719. 47 M 25. 572 Pain, left ankle and foot 719. 47 M 25. 579 Pain, unspecified ankle and foot Pain, Unspecified Joint 719. 40 719. 48 719. 49 M 25. 50 Pain, unspecified joint Documentation Tips • Site • Laterality – Right – Left – Unspecified • Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.

Documentation Tips Bone versus joint – For certain conditions, the bone may be affected at the upper or lower end, (e. g. , avascular necrosis of bone, M 87, Osteoporosis, M 80, M 81). Though the portion of the bone affected may be at the joint, the site designation will be the bone, not the joint.

Osteoarthritis of knee ICD-9 Code ICD-10 Code Description Excludes 1 Excludes 2 715. 96 M 17. 9 Osteoarthritis of knee, unspecified N/A • osteoarthritis of spine (M 47. -) There are more specific code choice selections below: M 17. 0 Bilateral primary osteoarthritis of knee M 17. 10 Unilateral primary osteoarthritis, unspecified knee M 17. 11 Unilateral primary osteoarthritis, right knee M 17. 12 Unilateral primary osteoarthritis, left knee M 17. 2 Bilateral post-traumatic osteoarthritis of knee M 17. 30 Unilateral post-traumatic osteoarthritis, unspecified knee M 17. 31 Unilateral post-traumatic osteoarthritis, right knee M 17. 32 Unilateral post-traumatic osteoarthritis, left knee M 17. 4 Other bilateral secondary osteoarthritis of knee M 17. 5 Other unilateral secondary osteoarthritis of knee

Documentation Tips Identify – Site – Laterality – Type • • Primary Post-traumatic Other secondary Unspecified

Osteoarthritis of hip ICD-9 Code ICD-10 Code Description Excludes 1 715. 95 M 16. 9 Osteoarthritis of hip, unspecified • bilateral involvement of single joint (M 16 M 19) Excludes 2 • osteoarthritis of spine (M 47. -) There are more specific code choice selections below: M 16. 0 Bilateral primary osteoarthritis of hip M 16. 10 Unilateral primary osteoarthritis, unspecified hip M 16. 11 Unilateral primary osteoarthritis, right hip M 16. 12 Unilateral primary osteoarthritis, left hip M 16. 2 Bilateral osteoarthritis resulting from hip dysplasia M 16. 30 Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip M 16. 31 Unilateral osteoarthritis resulting from hip dysplasia, right hip M 16. 32 Unilateral osteoarthritis resulting from hip dysplasia, left hip M 16. 4 Bilateral post-traumatic osteoarthritis of hip M 16. 50 Unilateral post-traumatic osteoarthritis, unspecified hip M 16. 51 Unilateral post-traumatic osteoarthritis, right hip M 16. 52 Unilateral post-traumatic osteoarthritis, left hip M 16. 6 Other bilateral secondary osteoarthritis of hip M 16. 7 Other unilateral secondary osteoarthritis of hip

Documentation Tips Identify: • Laterality Bone versus joint • For certain conditions, the bone may be affected at the upper or lower end, (e. g. , avascular necrosis of bone, M 87, Osteoporosis, M 80, M 81). Though the portion of the bone affected may be at the joint, the site designation will be the bone, not the joint.

Cardiac murmur, unspecified ICD-9 Code ICD-10 Code Description Excludes 1 726. 13 M 75. 110 Incomplete rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic • Tear of rotator cuff, traumatic (S 46. 01 -) Excludes 2 • Shoulder-hand syndrome (M 89. 0 -) There are more specific code choice selections below: M 75. 111 Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic M 75. 112 Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic

Documentation Tips Note: Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition Identify: • Laterality

Unspecified fracture of forearm ICD-9 Code ICD-10 Code Description Excludes 1 813. 40 S 52. 90 x. A Unspecified fracture of unspecified forearm • Traumatic amputation of forearm (S 58. -) There are more specific code choice selections below: S 52. 91 x- Unspecified fracture of right forearm S 52. 92 x- Unspecified fracture of left forearm The appropriate 7 th character is to be added to all codes from category S 52 A - initial encounter for closed fracture B - initial encounter for open fracture type I or II initial encounter for open fracture NOS C - initial encounter for open fracture type IIIA, IIIB, or IIIC D - subsequent encounter for closed fracture with routine healing E - subsequent encounter for open fracture type I or II with routine healing F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - subsequent encounter for closed fracture with delayed healing H - subsequent encounter for open fracture type I or II with delayed healing J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture type I or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture type I or II with malunion R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - sequela Excludes 2 • Fracture of wrist and hand level (S 62. -)

Documentation Tips • A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced. • The open fracture designations are based on the Gustilo open fracture classification • Identify: – Laterality

Low back pain ICD-9 Code ICD-10 Code Description Excludes 1 724. 2 M 54. 5 Low back pain • • • Loin pain Lumbago NOS • • • psychogenic dorsalgia (F 45. 41) low back strain (S 39. 012) lumbago due to intervertebral disc displacement (M 51. 2 -) lumbago with sciatica (M 54. 4 -) Excludes 2 N/A

Low Back Pain Documentation Tips • Document site and laterality – Unspecified codes should be used only in rare circumstances • With or without sciatica • Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition.

Trochanteric bursitis ICD-9 Code ICD-10 Code Description Excludes 1 726. 5 M 70. 60 Trochanteric bursitis, unspecified hip • bursitis NOS (M 71. 9 -) Applicable to: Trochanteric tendinitis M 70. 70 Other bursitis of hip, unspecified hip M 76. 10 Psoas tendinitis, unspecified hip M 76. 20 Iliac crest spur, unspecified hip Excludes 2 • • • There are more specific code choice selections below: M 70. 60 Trochanteric bursitis, unspecified hip M 70. 61 Trochanteric bursitis, right hip M 70. 62 Trochanteric bursitis, left hip bursitis of shoulder (M 75. 5) enthesopathies (M 76 M 77) pressure ulcer (pressure area) (L 89. -)

Documentation Tips Identify: • laterality

Carpal tunnel syndrome, unspecified upper limb ICD-9 Code ICD-10 Code Description Excludes 1 354. 0 G 56. 00 Carpal tunnel syndrome, unspecified upper limb • current traumatic nerve disorder - see nerve injury by body region There are more specific code choice selections below: G 56. 01 Carpal tunnel syndrome, right upper limb G 56. 02 Carpal tunnel syndrome, leftt upper limb Excludes 2 N/A

Documentation Tips Identify: • Laterality

Unspecified intracapsular fracture of femur ICD-9 Code ICD-10 Code Description Excludes 1 820. 00 S 72. 019 A Unspecified intracapsular fracture of femur • traumatic amputation of hip and thigh (S 78. -) Applicable to: • Subcapital fracture of femur Excludes 2 • • • There are more specific code choice selections below: S 72. 011 - Unspecified intracapsular fracture of right femur S 72. 012 - Unspecified intracapsular fracture of left femur The appropriate 7 th character is to be added to all codes from category S 72 A - initial encounter for closed fracture B - initial encounter for open fracture type I or II initial encounter for open fracture NOS C - initial encounter for open fracture type IIIA, IIIB, or IIIC D - subsequent encounter for closed fracture with routine healing E - subsequent encounter for open fracture type I or II with routine healing F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - subsequent encounter for closed fracture with delayed healing H - subsequent encounter for open fracture type I or II with delayed healing J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture type I or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture type I or II with malunion R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - sequela fracture of lower leg and ankle (S 82. -) fracture of foot (S 92. -) periprosthetic fracture of prosthetic implant of hip (T 84. 040, T 84. 041)

Documentation Tips • A fracture not indicated as open or closed should be coded to closed • The open fracture designations are based on the Gustilo open fracture classification • Identify: – Laterality – Open or closed

Pain in limb ICD-9 Code ICD-10 Code Description Excludes 1 729. 5 M 79. 60 - Pain in limb, unspecified • • psychogenic rheumatism (F 45. 8) soft tissue pain, psychogenic (F 45. 41) There are more specific code choice selections below: 729. 5 M 79. 62 - Pain in upper arm 729. 5 M 79. 63 - Pain in forearm 729. 5 M 79. 64 - Pain in hand fingers 729. 5 M 79. 65 - Pain in thigh 729. 5 M 79. 66 - Pain in leg 729. 5 M 79. 67 - Pain in foot and toes Excludes 2 • Pain in joint (M 25. 5 -)

Documentation Tips • Site • Laterality • Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

Sprain of unspecified rotator cuff capsule ICD-9 Code ICD-10 Code Description Excludes 1 840. 4 S 43. 429 A Sprain of unspecified rotator cuff capsule, initial encounter • 840. 4 S 43. 429 D Sprain of unspecified rotator cuff capsule, subsequent encounter 840. 4 S 43. 429 S Sprain of unspecified rotator cuff capsule, sequela rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M 75. 1 -) Excludes 2 • • Code also any associated open wound There are more specific code choice selections below: S 43. 421 - Sprain of right rotator cuff capsule S 43. 422 - Sprain of left rotator cuff capsule S 43. 429 - Sprain of unspecified rotator cuff capsule strain of muscle, fascia and tendon of shoulder and upper arm (S 46. -) injury of tendon of rotator cuff (S 46. 0 -)

Documentation Tips • Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code • The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes. • Identify: – Laterality

Secondary osteoarthritis, shoulder ICD-9 Code ICD-10 Code Description Excludes 1 715. 21 M 19. 219 Secondary osteoarthritis, unspecified shoulder • Polyarthritis (M 15. 1 -) There are more specific code choice selections below: M 19. 211 Secondary osteoarthritis, right shoulder M 19. 212 Secondary osteoarthritis, left shoulder Excludes 2 • • • arthrosis of spine (M 47. -) Hallux rigidus (M 20. 2) osteoarthritis of spine (M 47. -)

Documentation Tips Identify: – Laterality – Primary, Secondary, Post-traumatic

Displaced intertrochanteric fracture of femur ICD-9 Code ICD-10 Code Description Excludes 1 820. 21 S 72. 143 - Displaced intertrochanteric fracture of unspecified femur • traumatic amputation of hip and thigh (S 78. -) Excludes 2 • • • There are more specific code choice selections below: S 72. 141 - Displaced intertrochanteric fracture of right femur S 72. 142 - Displaced intertrochanteric fracture of left femur The appropriate 7 th character is to be added to all codes from category S 72 A - initial encounter for closed fracture B - initial encounter for open fracture type I or II initial encounter for open fracture NOS C - initial encounter for open fracture type IIIA, IIIB, or IIIC D - subsequent encounter for closed fracture with routine healing E - subsequent encounter for open fracture type I or II with routine healing F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - subsequent encounter for closed fracture with delayed healing H - subsequent encounter for open fracture type I or II with delayed healing J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture type I or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture type I or II with malunion R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - sequela fracture of lower leg and ankle (S 82. -) fracture of foot (S 92. -) periprosthetic fracture of prosthetic implant of hip (T 84. 040, T 84. 041)

Documentation Tips • A fracture not indicated as open or closed should be coded to closed • The open fracture designations are based on the Gustilo open fracture classification • Identify: – Laterality

Other specified postprocedural states ICD-9 Code ICD-10 Code Description Excludes 1 Excludes 2 V 45. 89 Z 98. 89 Other specified postprocedural states N/A Applicable To: • Personal history of surgery, not elsewhere classified Code also any follow-up examination (Z 08 -Z 09)

Documentation Tips Note: Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z 00 Z 99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A 00 -Y 89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways: (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury. (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

Monitor Claims On October 01, 2015 we will monitor claims for date of service rules • Outpatient claims cannot have crossover dates • Outpatient claims will be coded according to date of service • Inpatient facility claims will be coded per date of discharge We will monitor claims to resolve any unanticipated problems with the submission process

Claim Denial and Management • We will monitor for claim denials • We will monitor editing trends for ICD-10 Coding guidelines • We will provide feedback to the physicians regarding supporting documentation requirements • We will monitor WC or Liability carriers for published rules on use of ICD-9 or ICD-10 code sets

Client Responsibilities • Client will need to update – – Templates Order Sets Superbills Favorites • Future Orders – Remove ICD-9 code add ICD-10 code

Documentation – Start Now All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10 -CM code selection. • • Site specificity Document notation of qualifiers – – – • • Indicate acute or chronic Indicate underlying or external cause factors – – • Exacerbation Manifestations Relapse Status Stages Medication Smoke Accidents Mechanical failure Laterality – Bilateral – Right – Left

Documentation – Start Now • Episode of Care for injuries, poisoning, external causes and other conditions – Initial Encounter • Use while the patient is receiving active treatment of the condition – Active treatment includes surgical treatment, an emergency encounter, and evaluation and treatment by a new physician – Subsequent Encounter • Used on encounter after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. – Medication adjustments, aftercare, device adjustments, cast change – Sequela • Used for complications or conditions that arise as a direct result of a condition, late effect

Documentation – Start Now • Combination codes that capture – Etiology and manifestation – Related conditions – Disease, injury or other medical condition and complications – Disease or other medical conditions and common signs or symptoms • Add ICD-10 Codes to patient Problem List

Questions codingresource@g 1 hs. com Centers for Disease Control and Prevention (ICD-10 -CM) http: //www. cdc. gov/nchs/icd 10 cm. htm