Orthopedic Coding Alert

Coding for late effects of traumatic injuries is often poorly understood. When incomplete diagnostic information is passed on from surgeon to coder, the result can be a denied claim due to inaccurate reporting of the condition(s) being treated and a missed opportunity for legitimate reimbursement.
What Are They?
Late effects are long-term effects of, or conditions produced by, an injury or illness after the acute phase has resolved. Some late effects present early, while others might present months or years later. The codes (905.0-909.9) that define causes of late effects can be found under the heading Late Effects of Injuries, Poisonings, Toxic Effects, and Other External Causes'' in the ICD-9 manual. Those most commonly used in orthopedics include:
  905.0-905.5 late effect of fracture 905.6 late effect of dislocation 905.7 late effect of sprain and strain without mention of tendon injury 905.8 late effect of tendon injury 905.9 late effect of traumatic amputation
906.0-906.9 late effects of injuries to skin and subcutaneous tissues.  

Common Code Pairings for Orthopedics
When reporting conditions that are late effects of an acute injury, the primary diagnosis should be the residual problem/condition and the secondary diagnosis will be the late effects code. For example, 729.6 (residual foreign body in soft tissue) is the primary code and is paired with 906.1 (late effect of open wound of extremities without mention of tendon injury) as the secondary code.
 
Common orthopedic conditions that are always the late effect of an injury include:
  733.81 malunion of fracture 733.82 nonunion of fracture.
 
One of these codes would be sequenced first with the appropriate late effects code listed second. For example, a nonunion of the scaphoid is reported with 733.82 and 905.2 (late effect of fracture of upper extremities).
 
Code 718.8x (other joint derangement, not elsewhere classifiable) is often the late effect of a dislocation or sprain.
 
The following codes are often paired with the late effect of fracture codes (905.0-905.5): 997.6-997.69 (amputation stump complication) could be paired with 905.9 (late effect of traumatic amputation); 996.4 (mechanical complication of internal orthopedic device, implant and graft); 996.67 (infection and inflammatory reaction due to other internal orthopedic device, implant and graft); 996.78 (other complications due to other internal orthopedic device, implant and graft).
 
Code 730.1x (chronic osteomyelitis) can be the late effect of a traumatic bone injury (most likely an open fracture). 

Why Late Effects Matter
If a patient seeks treatment well after an accidental injury that occurred at work, and the carrier receives a claim [...]