Orthopedic Coding Clinic: Complete the ICD-9 Picture with These Tips

Posted on 23. Apr, 2009 by Editor in Hot Coding Topics

Code the condition your ortho treats first, followed by co-morbidity.

If you think you can bill only one diagnosis code per claim, you could be unintentionally sending your claim to limbo land. Find out how your ICD-9 codes can complete your patient’s story and even boost your claim’s success.

Use All the Appropriate ICD-9 Codes

Don’t believe the myth that you can bill only one diagnosis code.

Fact: Based on physician documentation, you should bill as many diagnosis codes as you need to establish medical necessity for the services you’re billing, says Kerry Sheskier, billing manager CPBS at Orthopaedic Dept./Physical Therapy of Winthrop Hospital in Bethany, N.Y. Medicare will process up to eight diagnosis codes.

AUDIO: Up Your Diagnostic-Related Pay with This Orthopedic Note Makeover.

“I always think of ICD-9 coding as telling a story,” says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, compliance and coding supervisor at Proliance Orthopedics and Sports Medicine in Bellevue, Wash. “The more complete your story, the more likely you’ll answer all of your carrier’s questions and get your claim processed.”

Remember: When reporting multiple diagnoses, “you should report only the codes that apply to the situation at hand and those that may change the outcome of treatment,” says Patrice A. Young, CPC, CMSCS, senior coder at Commonwealth Orthopaedic Associates in Reading, Pa. You should note that “not all underlying conditions are appropriate — such as when the patient has a cold and cough but fell and fractured her ankle.”

Apply These Concepts to This Situation

Scenario: Your surgeon submitted the following operative note, but you can’t determine which ICD-9 code applies. Should you report all diagnoses or just one?

“A frayed and detached superior anterior labrum with detachment of...

Tags: 29824, 29827, 718.31, 719.91, 727.61, 840.7, co-morbidity, diagnosis, ICD-9, modifier 22, orthopedic