Orthopedic Coding Alert

Avoid these ICD-9 codes when associated with compartment syndrome.

Reread the multi-trauma example on page 69. This time, highlight the diagnoses you see, and connect them to your CPT codes. Then compare with our experts advice.

Sort Out Your ICD-9 Options

Based on the scenario on page 69, the physician indicated the following ICD-9 codes for the day of admission:

 " 928.8 -- Crushing injury; multiple sites of lower limb
 " 825.0 -- Fracture of calcaneus, closed
 " 823.00 -- Fracture of tibia and fibula; upper end, closed; tibia alone
 " 813.05 -- Fracture ... head of radius
 " 810.00 -- Fracture of clavicle; closed; unspecified part
 " 958.92 -- Traumatic compartment syndrome of lower extremity.

Watch out: You should not report 729.81 (Swelling of limb) and 782.0 (Disturbance of skin sensation). According to ICD-9 guidelines, you should not report these symptoms associated with compartment syndrome.
Now that you have this list, you need to connect them to the CPT codes for your orthopedists services.

Link Them to Appropriate Procedures

Heres how you should link the ICD-9 codes to your CPT codes: For 27532-LT (Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction; left side), you should link 823.00.Similarly, you should link 20690-51-LT (Application of a uniplane [pins or wires in one plane], unilateral, external fixation system; multiple procedures) to 823.00, says Rebekah Constant, CPC, orthopedic/billing associate for Hawthorn Medical Associates, LLC in North Dartmouth, Mass.

Your other CPT codes should have multiple diagnoses attached. For instance, you should link 2760x-51-LT (Decompression fasciotomy, leg &) to 958.92.

Also, you should link 958.92 with 28008-51 (Fasciotomy, foot and/or toe).

Finally, you can link the initial hospital care code 99222-57 to all six of the above codes: 928.8, 825.0, 823.00, 813.05, 810.00, and 958.92.