Orthopedic Coding Alert

Increase specificity starting this October with the debut of several ICD-9 codes
 
If you-ve been waiting for a better way to describe the causes of your patients- myelitis or postoperative pain, help is finally on the way with several new diagnosis codes, which take effect on Oct. 1.
 
We-ve got a sneak peek at the new 2007 ICD-9 codes, and because payers do not allow a grace period for the new codes, you need to get acquainted with the newbies and update your superbills by Sept. 30.
 
Get to Know the New Pain Codes

Until the introduction of the new pain section (338.x), you-ve never had a way to describe -significant- pain, says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, coding manager for the University of Washington's physician group in Seattle. That includes pain that is outside what you-d expect, or requires extra treatment such as joint injections or pain service visits, Bucknam says.
 
The ability to code for acute or chronic postoperative pain will be useful for several different purposes, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies in Powder Springs, Ga. For example, you can use these codes to justify a pain management consultation, admitting a patient postoperatively or prolonging the patient's hospital stay.
 
The new pain codes are:

 - 338.0 -- Central pain syndrome

- 338.11 -- Acute pain due to trauma
 
- 338.12 -- Acute post-thoracotomy pain
 
- 338.18 -- Other acute postoperative pain
 
- 338.19 -- Other acute pain
 
- 338.21 -- Chronic pain due to trauma
 
- 338.22 -- Chronic post-thoracotomy pain

- 338.28 -- Other chronic postoperative pain
 
- 338.29 -- Other chronic pain
 
- 338.3 -- Neoplasm-related pain (acute) (chronic)
 
- 338.4 -- Chronic pain syndrome.

Look for Spine Code Updates

The new edition of ICD-9 will also debut several spine coding diagnoses that will help orthopedic practices. -Any of the codes with the prefix -myelo,- like the new code 284.2 (Myelophthisis), which is wasting or atrophy of the spinal cord, would be used in orthopedics or pain management, sometimes as a secondary code,- says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC (HCCE) in Boardman, Ohio. 
 
-In pain management, you have to watch the allowed diagnosis codes carefully, as Medicare/Medicaid only pay on allowed diagnosis codes,- Vogelberger says. -Hopefully these new codes will be added to their list.-

In addition, the following new ICD-9 codes will help spinal coders better pinpoint their patients- conditions:

- 341.20 -- Acute (transverse) myelitis NOS
 
- 341.21 -- Acute (transverse) myelitis in conditions classified elsewhere
 
- 341.22 -- Idiopathic transverse myelitis.

Compartment Syndromes Get Their Own Codes

The upcoming edition of ICD-9 will pinpoint several different traumatic and nontraumatic compartment syndrome codes:
 
- 729.71 -- Nontraumatic compartment syndrome of upper extremity
 
- 729.72 -- Nontraumatic compartment syndrome of lower extremity
 
- 729.73 -- Nontraumatic compartment syndrome of abdomen
 
- 729.79 -- Nontraumatic compartment syndrome of other sites
 
- 958.90 -- Compartment syndrome, unspecified
 
- 958.91 -- Traumatic compartment syndrome of upper extremity
 
- 958.92 -- Traumatic compartment syndrome of lower extremity

 - 958.93 -- Traumatic compartment syndrome of abdomen

 - 958.99 -- Traumatic compartment syndrome of other sites.

And if you-ve ever wondered which pain code you should report when the surgeon documents -generalized pain,- you now have an answer -- 780.96 -- although some coders believe that orthopedic surgeons normally see more precisely defined pain syndromes. -The new generalized pain code 780.96 may not be of too much use because orthopedic coders would normally choose a more specific code,- Vogelberger says. 
 
In addition, orthopedic practices might be pleased to discover 731.3 (Major osseous defects) on the list of new diagnosis codes effective Oct. 1.
 
-V- Codes Signal Dressing- and Suture-Related Visits
 
The ICD-9 guidebook will also unveil several new -V- codes to help supplement your primary diagnoses:
 
- V58.30 -- Encounter for change or removal of nonsurgical wound dressing

- V58.31 -- Encounter for change or removal of surgical wound dressing
 
- V58.32 -- Encounter for removal of sutures.

-These diagnoses will be useful, although the procedures used with these codes may be included in the global surgery package and not payable,- Vogelberger says. -And that's OK because diagnosis codes are used to track patient care and provide medical necessity, not just to get a claim paid. These statistics are used for performance measurement to develop and shape our healthcare in the future.-