Orthopedic Coding Alert

Refresh your coding essentials with this step-by-step ICD-9 selection If you-re eager for feedback on your coding without the stress of auditors, here's your chance. Decide which CPT and ICD-9 codes you would choose for your orthopedic surgeon for this case study, shared by Mariellen Murray, chief operating officer at The Florida Knee and Orthopedic Centers, and then check your answers against the expert's below. Analyze This Op Report Pre-op diagnosis: left knee DJD varus Post-op diagnosis: left knee DJD varus Operation: partial knee resurfacing with patelloplasty, diagnostic arthroscopy, plastic skin closure, pain pump catheter placement Components: (see hospital operative form for sizes and types) Procedure: After satisfactory anesthesia, the leg was placed in the leg holder, prepped and draped in the usual sterile manner. Tourniquet inflated. Diagnostic arthroscopy performed showing medial compartment degenerative changes and no other abnormality. A straight longitudinal incision was made parallel to the patellar tendon. Medial parapatellar arthrotomy performed. Fat pad partially resected. Capsule and collateral ligament elevated subperiosteal to expose proximal tibia. Patelloplasty performed. Hohmann retractor inserted. Posterior femoral condyle removed with saw. Femoral and tibial osteophytes removed with a rongeur. Proximal tibia prepared with a saw and burr until appropriate-sized trial could be inserted. Distal femur sized with drill guide, and pilot hole was drilled. Femoral condyle prepared with a burr. Trials inserted. Knee extended and put through its range of motion to determine alignment and ligament balance. Trials removed. Bone irrigated with pulsatile lavage and dried. Tibia and femoral components inserted with bone cement. Excess cement removed. Knee held in extension until cement cured. Percutaneous pain pump catheters were placed intra-articular and subcutaneously before closing. Wound irrigated and closed in layers with plastic technique, which included a subcuticular skin closure. Bandage applied, tourniquet deflated. ICD-9 Conventions Help Pinpoint Proper Dx Codes The surgeon first documents a diagnosis of "left knee DJD varus." Translation: The patient has degenerative joint disease (DJD)m and the distal portion of the extremity is deviated inward, making the patient appear bowlegged (varus). ICD-9 solution: You should report 715.36 (Osteoarthrosis, localized, not specified whether primary or secondary; lower leg) for the DJD and 736.42 (Genu varum [acquired]) for the varus deformity, says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC. DJD: The doctor documents left knee DJD. Under the entry "Degeneration, degenerative" in the ICD-9 index, you find "joint disease (see also Osteoarthrosis)" and 715.9x. You should always check codes listed in the index in the tabular list to verify they-re the best choice. If you check the listed code, 715.9x (Osteoarthrosis, unspecified whether generalized or localized), in the ICD-9 tabular list, you-ll see that this is an unspecified code. ICD-9 conventions state [...]