Orthopedic Coding Alert

No longer will you look to 832.0 for nursemaids elbow.

Does your orthopedist treat childrens arm problems with regularity? If so, then you may have three new ICD-9 codes to use as of Oct. 1. Take advantage of this sneak peak of the proposed orthopedic additions, and youll be ahead of your peers.

Benefit: Most of the new codes will offer additional specificity to existing diseases, which can help you code more accurately. Any time we get diagnosis codes that provide additional specificity, I think that is great, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver.

Orthopedic coders, however, had hoped for a wider range of codes, says Leslie A. Follebout, CPC, COSC, PCS, coding manager at Peninsula Orthopaedic Associates in Salisbury, Md.

For instance, you may not celebrate the addition of fifth digits to existing codes 274.0 (Gouty arthropathy) and 453.8 (Other venous embolism and thrombosis of other specified veins). You may, however, find some brand-new additions.

Heres 3 New Codes to Use in Pediatric Cases

If your orthopedist treats pediatric patients for fractures, then youre used to applying forearm fracture ICD-9 codes. These constitute nearly half of all childhood fractures. ICD-9 2010 may bring you two new torus fracture options: 813.46 (Torus fracture of ulna [alone]) and 813.47 (Torus fracture of radius and ulna).

Torus fractures are sometimes called buckle fractures, and they are stable and nondisplaced. What happens is the topmost layer of bone on one side is slightly compressed. Following the descriptors, youll report 813.46 when the patient fractures only the ulna.

When the patient fractures both, youll use 813.47.

Be careful: You shouldnt confuse these codes with the existing torus fracture code 813.45 (Torus fracture of radius) and other radius and ulnar fracture codes specified in the 813.xx (Fracture of radius and ulna) range.

Secondly, youll need to know 832.2 (Nursemaids elbow). Most likely, you will use 832.2 for pediatric patients between 1 to 3 years of age.

This condition is a subtle subluxation of the elbow joint -- specifically the radio-capitellar joint. By suddenly pulling on an uncooperative childs arm, adults can cause this condition. Your orthopedist may also use the term radial head subluxation.

Currently: As for now, ICD-9 directs you to 832.0x (Dislocation of elbow; closed dislocation) for this condition, Follebout says.

To read the complete list of proposed new, revised, and deleted ICD-9 codes that may take effect on Oct. 1, visit http://edocket.access.gpo.gov/2009/pdf/E9-10458.pdf and scroll to page 409. CMS will publish the full listing of ICD-9 codes in the May 22 Federal Register but released the list early.