Orthopedic Coding Alert

"Orthopedic practices will finally be able to specify muscle weakness diagnoses, thanks to a new ICD-9 code that takes effect Oct. 1. CMS unveiled the new diagnosis codes in the May 19, 2003, Federal Register, revealing several new diagnosis codes that will affect orthopedic practices.
Welcome, 728.87!  
Now, if a patient presents to your practice complaining of muscle weakness, your only choice is to report the unspecified code, 728.9 (Unspecified disorder of muscle, ligament, and fascia). Beginning in October, however, orthopedists should instead assign the new code 728.87 (Muscle weakness), which more accurately describes the patients condition.
 
Most physicians are unsure of what unspecified codes such as 728.9 include, says Mary J. Brown, CPC, CMA, orthopedic coding specialist at OrthoWest PC, a seven-physician practice in Omaha, Neb. More descriptive ICD-9 codes like 728.87 help paint a picture for your insurer, and that can save time by staving off unnecessary denials and appeals.
 
Not only do physicians and insurers moan when faced with unspecified codes, but coders dismay even more, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
 
Most coders prefer not to use unspecified codes unless there are no other options, Hammer says, but, because muscle weakness is a fairly common diagnosis in geriatric populations and postsurgical rehabilitation patients, practices had no other choice than to report 728.9.
728.9 Is Not Gone
But CMS has not deleted 728.9, and practices should still assign it for other muscle, ligament and fascia conditions that the more specific ICD-9 codes do not already describe.
 
Practices might also use 728.87 in situations when they formerly reported 780.79 (Other malaise and fatigue), Hammer says. Reporting 780.79 was definitely not a great fit when treating generalized muscle weakness. The addition of 728.87 will help you clearly document the need for inpatient stays and compliantly coding the signs and symptoms in an outpatient setting before the physician determines a firm diagnosis.
V64.43 Describes Converted Surgeries  
CMS also introduced V64.43 (Arthroscopic surgical procedure converted to open procedure), but this new code may not pack as much punch as some practices expect, Brown says. If an arthroscopic procedure is converted to an open procedure, you should only report the open procedure, so the conversion diagnosis code probably wont be exceedingly useful, she says.
 
Its possible that this new code might apply if you perform an arthroscopic procedure, and then convert it to an open procedure for a separately identifiable condition in the same site, Brown says.
 
For example, suppose the surgeon performs an arthroscopic decompression of the subacromial space (29826, Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release), during which she discovers a torn rotator [...]