Orthopedic Coding Alert

It's time to replace the outdated ICD-9 codes with the new and revised diagnosis codes, but before you take that plunge, refresh your diagnosis coding skills with this tip that makes ICD-9 coding a breeze.

Tip: Forget that fifth digit and forget reimbursement. Orthopedic coders who omit a required fifth digit when submitting ICD-9 codes, such as those for arthritis (715.00-716.99), can expect claim denials, delays and rejections. The purpose of the fifth digit is to allow you to provide greater detail, and when required, you must report it to facilitate reimbursement because a code is invalid if you haven't used the full number of digits required. Fifth digits add additional information to the code, such as the anatomic location for arthritis codes.

Best practice: If you-ve dealt with denials due to missing fifth digits, you should print the applicable ICD-9 codes, including the fifth digits, right on your superbill. For instance, you could include all of the fracture codes most frequently used in your practice, including the fifth digits. That way, the physicians simply have to circle the correct site (such as 814.12 for an open fracture to the lunate bone of the wrist).

If you don't have enough room on your superbill to list every last fifth digit, you should place a line after codes that require a fifth digit, experts say. For instance, you might list the codes as 814.0__, 814.1__, and so on. Then the person sending in the claims would be reminded to look up the appropriate digit to put on the diagnosis code.