Orthopedic Coding Alert

Know your anatomic terms and you-ll find the right diagnosis codes every time If you don't know what differentiates an acute condition from a chronic one, or what separates an active injury from lingering pain, you could find yourself in a bind. Check out the following four frequently asked questions to get quick tips to help your ICD-9 coding. Is DDH Subluxation or Dislocation? Question #1: Our surgeon saw a baby with developmental dislocation of the hip (DDH). He documented the baby's problem with the terms -subluxation- and -dislocation.- Since ICD-9 doesn't include a diagnosis code for DDH, I was planning to use a subluxation or dislocation code, but I can't decide which term applies more. What is the difference between subluxation and dislocation?

Answer: Subluxation describes a partial or incomplete dislocation, meaning that the patient has suffered partial loss of the joint's congruency, says Chris P. Galeziewski, CPC, an orthopedic coder at the Kelsey-Seybold Clinic in Houston. -Dislocation is the complete removal of the joint from the socket,- he says.

Key point: If the patient suffered congenital subluxation, he most likely had an inborn laxity or prestretching of the ligaments and/or attaching musculotendinous groups or attachments, which do not allow a total disjointing of the femoral head, Galeziewski says. Therefore, the patient did not experience a complete dislocation.

Your best coding choice for this condition would probably be 754.32 (Congenital subluxation of hip, unilateral) for unilateral DDH, or 754.33 (Congenital subluxation of hip, bilateral) if both of the patient's hips were affected. Do Injury Codes Apply to Pain? Question #2: I-m looking for the coding guidelines that describe when I can report code 840.4 versus 726.10 or 727.61. Our surgeon recently performed a rotator cuff repair, and his notes document -pain for the past nine months.- Someone told me that we cannot report an acute injury code for this service and that we should select another code instead. Is that accurate?  Answer: Yes. Code 840.4 (Sprains and strains of shoulder and upper arm; rotator cuff [capsule]) is from the -injury- chapter of the ICD-9 guidebook. In your case, the patient didn't suffer an injury--instead she experienced nine months of pain that warranted the procedure.

Therefore, you should avoid 840.4 and select another code based on the rest of the surgeon's documentation, such as 727.61 (Complete rupture of rotator cuff) or 726.10 (Disorders of bursae and tendons in shoulder region, unspecified) instead. Acute Vs. Chronic Injuries: How to Decide Question #3: How can we differentiate an acute injury from a chronic one? Answer: -An acute condition is sudden and severe. A chronic condition is a longer developing syndrome, persistent, continuing, or recurring, but may have been caused by an acute injury,- says Susan [...]