Orthopedic Coding Alert

What's so difficult about coding for orthopedics? Thoughts of the human skeleton immediately bring up thoughts of Halloween and all sorts of scary things. So coding for orthopedics is bound to be scary as well, right? Not in the least. It's all basic anatomy.

I-ll never forget my introduction into the importance of at least a cursory knowledge of anatomy in orthopedic coding.

I was the coding supervisor for a large orthopedic practice in North Carolina, and a long-term employee transferred a call from a Medicare patient. The patient was irate because she had been billed for "a broken neck" repair although she had never been treated for a broken neck. She wanted her medical record corrected immediately.

The patient account representative was appalled at the practice's inappropriate coding and transferred the call to me to handle. When I first took the call, I too was embarrassed that my department had made such a mistake in billing. Upon listening to the patient's history and subsequent treatment, however, I found that the "broken neck" the patient had experienced was actually a true orthopedic problem that had been diagnosed correctly -- a fracture of the femoral neck.

Lesson learned: If you are an orthopedic coder, you probably recognize the humor in that story. If orthopedics is new to you, or you typically code for another specialty, you may not realize that a femoral neck fracture is a fracture far away from the neck that holds your head up. The femoral neck is actually the neck of the femur, which is the large bone of the leg. So this patient had fractured her hip --not her neck. A quick anatomy lesson consoled both the patient and the account representative.

Orthopedics is truly applied anatomy, which is simply the practical application of anatomical knowledge to diagnosis and treatment. That much we know from the story illustrated above.

An understanding of the human anatomy will improve your orthopedic coding expertise one hundred fold. Don't let that statement deter you. You don't need to know the human anatomy from head to toe. You just have to know where to find the information about any given diagnosis.

There are a total of 206 bones in the body -- 54 bones in the hands and 52 in the feet. You don't need to memorize every one of those bones to code correctly. You just need to know where to find the pertinent information when called on to code diagnoses and conditions in every area of the body. A pictorial skeleton with all bones notated is a must for any coder's desk (see sample diagrams below and on page 88).

Muscles are another important part of orthopedic coding. There are more than 630 muscles in the body. Your body weight is about 40 percent muscle -- so that daily jog to the scales should be tempered by the fact that almost half of the total is muscle weight.

Muscles are the engines that allow bones to move and function. Without them you simply could not move your body. With them, you have frequent visits to the orthopedist with the common complaint of "oh, my aching back" or "my muscles ache."

Tendons are bands of tissue that attach muscles to the bones. They are typically named for the muscle group that they attach. For instance, the quadriceps tendon attaches the quadriceps muscle to the patella.

On the other hand: Ligaments are elastic bands of tissue that attach bone to bone. They are often named for the bones that they connect.

For instance, the scapholunate ligament attaches the scaphoid bone to the lunate. The glenohumeral ligament attaches the glenoid to the humerus.

And then comes the common complaint in orthopedics, "oh, my aching joints." A joint is simply the point of connection between two bones -- most especially when that joint allows motion.

When you hear you have to code a problem in the glenohumeral or radiocapitellar joint, you might think that this sounds so complicated.

Glenohumeral: In reality, the glenohumeral joint is simply the joint of the glenoid, which is a portion of the scapula, to the humerus, which is the upper arm.

Where do you go in the CPT manual? To the shoulder section (23000-23929).

Radiocapitellar: Likewise, the radiocapitellar joint is where the radial head -- or the head of the radius -- joins the capitellum, or the end of the humerus.

Where do you go in the CPT manual? That's right -- the elbow section (23930-24999).

So orthopedic coding seems daunting, just by the CPT manual's many subsections of the musculoskeletal section.

But with a basic understanding of the human body -- the bones, muscles, ligaments and tendons -- you will be well on your way to developing your coding expertise in the orthopedic area. An anatomy book should carry you even further.

Resource: The orthopedic surgeon you work for may be the greatest encyclopedia available to you. Help may be just a question away. Your doctors want you to provide them with proper coding, and they are more than happy to clear up any doubts that you have about the location of a certain bone, muscle or tendon.

Example: A spine surgeon once helped me immensely with the simple facts of proper dining along with the bone areas of the spine:

- breakfast should be at seven (seven cervical vertebrae, C1-C7)

- lunch should be at 12 (12 thoracic vertebrae, T1-T12)

- dinner should be at five (five lumbar vertebrae, L1-L5).

Of course, if you are faced with a difficult coding case and your surgeon is nowhere to be found, you can always phone a friend (with Internet coding chat rooms and forums, help is just a click or phone call away), or you can take a trip back to your childhood: The hip bone's connected to the thigh bone. The thigh bone's connected to the knee bone.