Orthopedic Coding Alert

You can get a head start on the shift from ICD-9 2008 to ICD-9 2009 today with this preview of the changes you-ll soon be applying for soft-tissue disorders, osteoporosis and more.
Note: Consider these changes tentative until ICD-9 releases the final list, which may include more changes. Remember: You must begin using ICD-9 2009 codes for services on or after Oct. 1, 2008.

ICD-9 2009 may expand your 729.9 (Other and unspecified disorders of soft tissue) coding options by adding more specific fifth digits.

Impact on you: Orthopedic coders will use 729.91 (Post-traumatic seroma) and 729.92 (Nontraumatic hematoma of soft tissue), says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.

If the documentation doesn't provide enough information to assign one of these more specific codes, you-ll have 729.90 (Disorders of soft tissue, unspecified).

And if the surgeon documents a specific diagnosis, but ICD-9 doesn't offer a precise code for that diagnosis, you-ll be able to report 729.99 (Other disorders of soft tissue).

The ICD-9 Coordination and Maintenance (C&M) Committee has been contemplating revising the 998.3x (Disruption of operation wound) range since September 2007, and the National Center for Health Statistics (NCHS) is hoping to push these changes through for implementation this October.

Watch for this change: One revision would add 998.33 (Disruption of traumatic wound repair), which could be useful for orthopedics, Stout says.

A note with this code will tell you it's for "disruption or dehiscence of closure of traumatic laceration (external) (internal)."

"Unspecified" switch: ICD-9 may also add 998.30 (Disruption of wound, unspecified). In 2008, you instead report this "not otherwise specified" operation wound disruption with 998.32 (Disruption of external operation wound), says Patrick Romano, MD, MPH, professor of medicine and pediatrics at the University of California Davis in his presentation to the C&M committee, "ICD-9-CM Coding Proposals" (www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm).

Other revisions add notes to the existing codes to help you know when to report them. Examples: A note with 998.3x would clarify that this range is for "disruption of any suture materials or method." The notes for 998.31 (Disruption of internal operation wound) will include "disruption or dehiscence of closure of" the following, among others:

- fascia, superficial or muscular

- muscle or muscle flap

- tendon or ligament.

And 998.32 will include "disruption or dehiscence of closure of" the following, among others:

- skin

- subcutaneous tissue

- full-thickness skin disruption or dehiscence

- superficial disruption or dehiscence of operation wound.

Benefit: The additional terms should help you choose the correct code. "Physicians tend to document the tissues and/or layers involved, rather than using the terms -internal- and -external,- " Romano says.

ICD-9 2009 may bring these history-of-fracture V codes your way, too:

- V13.51 -- Personal history of pathologic fracture

- V13.52 -- Personal history of stress fracture

- V13.59 -- Personal history of other musculoskeletal disorders

- V15.51 -- Personal history of traumatic fracture

- V15.59 -- Personal history of other injury.

Watch for: ICD-9 may add a note to 733.0x (Osteoporosis) requiring you to report V13.51 for patients with a personal history of pathologic fracture. Patients with this history are more likely to experience additional fractures, and this history affects treatment, according to the ICD-9 C&M Committee March 2007 meeting agenda (http://www.cdc.gov/nchs/data/icd9/agendamar07.pdf).

In an ideal world: The codes would prove useful if CMS allowed bone mass measurement payment for men because of a history of fractures, says Leslie Follebout, CPC-ORTHO, PCS, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md. Surgeons often consider this history a valid reason to perform the test.

Resource: Please e-mail deborahd@eliresearch.com for CMS- list of preliminary ICD-9 codes.