Orthopedic Coding Alert

Question: I recently heard that the ICD-9 guidelines for billing x-rays were updated but I can't find anything about it. Can you advise me where to find it?

New Jersey Subscriber

Answer: The latest ICD-9 Official Guidelines, which were effective Nov. 15, include some new advice for coders who submit x-ray claims. The following information is the most relevant to orthopedic coders:

- Pain: Do not report the new pain codes in category 338.x (Pain, not elsewhere classified) if the underlying (definitive) diagnosis is known, unless the reason for the encounter is pain control rather than management of the underlying condition.
 
You can use a code from category 338.x as the principal or first-listed diagnosis when the encounter is for pain control (for example, epidural steroid injection for back pain), even if the cause of the pain is known. If the cause is known, you should code it as a secondary diagnosis.

- Pathologic fractures: Report 733.1x (Pathologic fracture) for newly diagnosed pathologic fractures and when the patient receives active treatment (such as in the emergency department or when treated by a new physician).

- Acute fractures: Code traumatic fractures with acute fracture codes 800-829 while the patient is receiving active treatment.

The updated ICD-9 coding guidelines are available at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.

Reader Questions were reviewed by Heidi Stout, CPC, CCS-P; and Bill Mallon, MD.