Orthopedic Coding Alert

Dural tears may get the spotlight in next year's new codes As if the more than 330 potential new diagnosis codes CMS published for 2009 aren't enough, a few more codes may find their way in by Oct. 1. Here's a peek at what could be in store. Durotomy Codes Are Up in the Air Possible new incidental durotomy code choices would prove useful for those who code spine surgery, says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network. You may see your surgeon use terms such as "incidental durotomy" or "dural tear" for an unintended dura mater tear during spine surgery. The tear may also occur during other invasive extradural procedures, such as epidural injections. Now the ICD-9 index points you to 998.2 (Accidental puncture or laceration during a procedure) for a dural tear, says John D. Shaw, president of Albany, N.Y.-based Next Wave, in his March 2008 presentation to the ICD-9 Coordination and Maintenance (C&M) Committee, "Incidental Durotomy/Dural Tear," online at http://www.cdc.gov/nchs/ppt/icd9/att5ShawMar08B_97-03.ppt. But because dural tears require repair, they should have a unique code, Shaw says. Watch out: Many surgeons expect dural tears because they are common for certain procedures (such as revision spine surgery), so surgeons don't document the tears as complications. That makes your job tougher because you don't know whether to code the tear. A distinct code and multiple "code also" notes may help change that. Shaw offered two options, with a preference for the following: - add new code 349.3 (Dural tear) - add "use additional code for associated conditions" note, including curvature of spine (737.0-737.9), intervertebral disc disorders (722.0-722.93), and postlaminectomy syndrome (722.83), among others. The other option would have the same "use additional code" notes, but it would create new accidental puncture codes: - 998.20 -- Accidental puncture or laceration during a procedure, unspecified site - 998.21 -- Accidental puncture or laceration of dura during a procedure. - 998.29 -- Accidental puncture or laceration during a procedure, other specified site. Keep This Code for Children Under 5 Nursemaid's elbow -- radial head subluxation commonly seen in children younger than 5 years of age -- also may get its own code in 2009. Now, ICD-9 directs you to 832.0x (Dislocation of elbow; closed dislocation) for this condition, says Leslie Follebout, CPC-ORTHO, PCS, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md. This coding option doesn't cause any issues, but "adding the specific category for a nursemaid's elbow will allow separation (for tracking) of a nursemaid's elbow from other types of dislocation of the elbow," Follebout says. The proposed new code would be 832.2x (Subluxation of radial head), with a note specifying that the code is for [...]