Tag Archives: orthopedic
Orthopedic Coding Clinic: Labral Tears
Posted on 28. Jan, 2010 by Editor.
10-2:00 in the op note signals SLAP lesion repair.
Even experts can land on the wrong ICD-9 code for SLAP lesion repair, but visualizing the injury region as a clock will help you distinguish one type of SLAP (superior labral anterior posterior) tear from another.
Research Patient History for Accurate Diagnosis
Having a solid understanding of anatomy and knowing the severity of the patient’s situation give your coding a firm foundation.
Define it: The labrum is the rim of cartilage that deepens the shoulder socket (glenoid) and increases joint stability. The superior portion of the labrum can be torn when the shoulder dislocates forwardly (anteriorly). This results in a SLAP lesion — a tear of the superior labrum, anterior to posterior, says William J. Mallon, MD, an orthopedic surgeon and medical director of Triangle Orthopaedic Associates in Durham, N.C.
Patients can acquire a SLAP lesion after falling down, or following repeated overhead actions such as throwing a football. Symptoms include pain, swelling, and an occasional “clicking” sound when moving the arm in a throwing position.
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Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010
Posted on 29. Oct, 2009 by Editor.
Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready for a facet joint codes shift that preps for ICD-10.
The 2010 version of CPT attempts to organize the facet joint injection codes by deleting 64470-64476 and debuting 64490- 64495 in their place, as follows:
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
• 64491 — … second level
• 64492 — … third and any additional level(s)
• 64493 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
• 64494 — … second level
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ASC Coding Education: Knee Diagnoses & Procedures
Posted on 18. Oct, 2009 by Editor.
Choose this ICD-9 code if you see ‘jumper’s knee’ in the orthopedic surgeon’s note.
Here’s a handy introduction to common ICD-9 codes related to the knee, along with examples of CPT codes for procedures physicians perform to treat knee diagnoses.
Chondromalacia Patella
Chondromalacia patella (717.7) is also known as “patellofemoral syndrome” or “runner’s knee.” This condition results when the cartilage under the patient’s patella becomes damaged and causes pain particularly when the patient climbs stairs or bends his knee.
This is a common condition among runners or other athletes who jump, squat or climb. But chondromalacia patella can also be associated with arthritis, so the condition affects patients in all age groups.
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Orthopedic Coding Quick Start Guide: ASC Shoulder Procedures
Posted on 11. Oct, 2009 by Editor.
Shoulder ICD-9 and CPT codes you’ll most likely see in the orthopedic ASC setting — explained.
If you’re an orthopedic coder, you don’t have to shoulder your shoulder coding burdens alone. We’ve rounded up a handy reference list of shoulder problems (along with sample procedures that fix them) that you’ll come across in an ambulatory surgical center setting.
AC Joint Separation
A separation of the acromioclavicular (AC) joint (831.04, Dislocation of shoulder; acromioclavicular [joint]), also called a “shoulder separation,” occurs when the clavicle and acromion separate due to a strain, sprain or tear of one or more shoulder ligaments. In the most serious form of AC joint separation, both the acromioclavicular ligament and the coracoclavicular ligament are completely torn. These injuries often occur following a fall or a direct blow to the shoulder, often during sports, and can cause intense shoulder pain.
If the injury is a grade 1 separation (a sprain without ligament tearing) or a grade 2 separation (with partial ligament tearing), surgeons usually prescribe pain medication and stabilize the joint using a sling. If the patient suffers a grade 3 separation with tearing of both ligaments and does not respond well to conservative treatment, the surgeon may opt to perform an AC joint stabilization surgery, also known as a Weaver-Dunn reconstruction (23550 or 23552).
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Orthopedic Coder’s Anatomy: The Hip
Posted on 26. Sep, 2009 by Editor.
These key terms make coding for hip procedures easier and more accurate.
If you think your hip is that thing jutting out at you in the mirror, your nomenclature needs a rehaul to ensure you’re nailing the correct codes. Coding for hip fractures and other procedures is easier when the coder is hip to the anatomy and terminology.
Common mistake: The average person refers to the prominent part of the pelvis that juts out just below the waistline (the iliac crest) as the hip. However, the hip portion of the pelvis is really about five inches below and is called the acetabulum, or “true hip.”
The ABCs of Hip Anatomy
Hip joint: Three areas of the pelvic structure form the acetabulum or the socket: the ilium, the ischium, and the pubis.
Femoral head: This is the “ball,” which is located in the upper end of the femur. The femoral head and the acetabulum are covered with a layer of cartilage that provides shock absorption and load distribution within the hip.
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Test Yourself: Total Knee Replacement (TKR) Coding
Posted on 20. Sep, 2009 by Editor.
Can you tackle an op note like this one we got our hands on? Relax. We help you break it down into 3 steps.
Although you may be accustomed to TKR op notes, an unusual case might send you into a panic. Take a deep breath, and we’ll have you breezing through the challenges that atypical TKR op notes present, like coding for a necrotic bone graft from a prior fixation.
First, Read the Op Note
Review the op report and code the procedure on your own. Then check out our expert advice below.
Preoperative diagnosis: Status post severe bicondylar proximal tibia fracture, and post open reduction internal fixation with bone grafting (failed).
Procedure overview: The surgeon scheduled a patient for hardware removal (from a tibia fracture), as well as a total knee replacement. When he opened the patient, he found it necessary to perform major deep hardware removal, tibial tubercle reconstruction, trabecular metal coil insertion, wedge medial tibial base plate, and long stem tibial component (total knee replacement).
AUDIO TRAINING EVENT: Keep your revenue limber with these spot-on knee coding tips.
The pertinent details of the op report follow: After I opened the patient, I noted an obvious nonunion of the tibial tubercle. I removed the tibial tubercle wires and removed the plates and found that the massive amount of bone grafts that we had used intraoperatively had not consolidated and there was a tremendous amount of necrotic bone. I ununited the medial tibial plateau and discarded the large (3-cm) piece.
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Steer Clear of This Modifier 22 Mistake
Posted on 04. Sep, 2009 by Editor.
Question: Our orthopedist did a right knee arthroscopy with extensive tricompartmental synovectomy, partial medial menisectomy, and chondroplasty of patella and femoral trochlea. I’m using 29876, 29881, and G0289 — but I’m not sure if G0289 is right. Also, when the doctor states “extensive,” should I use modifier 22 on 29876?
Answer: You should report only 29876 (Arthroscopy, knee, surgical; synovectomy, major, two or more compartments [e.g., medial or lateral]) and 29881 (… with meniscectomy [medial OR lateral, including any meniscal shaving]).
Warning: You should not report G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee), because the orthopedist performed the chondroplasty in the same knee compartment as synovectomy.
As for modifier 22 (Increased procedural services), you should be wary when your physician dictates “extensive.” His documentation would need to specify a lot of extra time involved, because no other route could justify a modifier 22 on the arthroscopy.
AUDIO: Coding Essentials for Knee Procedures.
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Spinal Surgery Coding Challenge: Tethered Cord Release & Dural Tag Removal
Posted on 14. Aug, 2009 by Editor.
Question: My neurosurgeon released a tethered cord under the microscope, then excised a dural tag and sent it to pathology. Can we be reimbursed for both services, or are they inclusive?
Answer: The procedure removes adhesions (tags) from the dura to correct any neurological deficits. Physicians often remove a specimen to send for lab review, but that service is included in the primary procedure.
In this situation, you’ll report 63200 (Laminectomy, with release of tethered spinal cord, lumbar) for the cord release and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microscope use. Don’t report the dural tag removal separately, as it is incidental to the tethered cord release.
Audio Training Event: Spinal Surgery Coding Secrets, with Dr. Greg Przybylski.
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ICD-9 Coding Tool for Hand, Wrist Fractures
Posted on 31. Jul, 2009 by Editor.
Here’s how to differentiate the tiquetrum from the trapezium.
Orthopedic surgeons dealing with hand procedures don’t only treat dislocations — they also treat fractures, and it’s up to you to link the correct diagnosis to the upper-extremity fracture repair code.
Use the anatomic drawing here to locate the site that your surgeon addressed, and match that to the sampling of applicable ICD-9 codes in the chart at the bottom of this page.
Your hand surgery claims will come out picture-perfect, and denial-free. 
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Weber B Fracture Repair: 27786, 27788 or 27792?
Posted on 24. Jul, 2009 by Editor.
Question: Which CPT and ICD-9 codes should we report when the surgeon dictates a Weber B fracture repair?
Answer: Depending on whether the surgeon performed an open or closed repair, you should select a code from the following range for a Weber B fracture:
• 27786 – Closed treatment of distal fibular fracture (lateral malleolus); without manipulation
• 27788 – … with manipulation
• 27792 — Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed.
Orthopedic surgeons often use terms in their dictation that don’t appear in CPT, and “Weber B” is one of those. When a surgeon addresses a Weber B fracture, he is usually treating a fracture in the distal fibula, which is coded as a lateral malleolar fracture (824.2-824.3).
The Weber classification describes only the level of the distal fibular fracture, which could also be part of a bimalleor or trimalleolar fracture pattern (although rare), or a lateral malleolar fracture. Type A describes the distal fibular fracture below the ankle syndesmosis. Type B has the distal fibular fracture intersecting the syndesmosis, and Type C involves the distal fibular fracture above the syndesmosis. Patients may have a concomitant medial malleolar fracture, which, if treated, would be coded as a bimalleolar ankle fracture.
AUDIO: Documentation checklist for orthopedic surgeons, and more.
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