Orthopedic Coding Alert

New E codes in ICD-9 have multiplied your options for accurate diagnosis coding, but learning to incorporate them with other choices sometimes trips up coders. "I love all the new E codes that have been added," says coder Carol Wilson, practice administrator for Leesburg Orthopaedics in Leesburg, Va. "I think it would be interesting to learn how to use them on the same claim as V codes."

If you've been wondering the same thing, read on for easy ways to file a claim with both E and V codes.

You can look to the ICD-9 2010 guidelines for distinguishing E code characteristics and their diagnostic purpose. When assigning an E code, be sure to follow these rules:

• Classify environmental events, circumstances, and conditions as the cause of injury, poisoning, and other adverse effects with an E code(s).

• Report an E code(s) in addition to a code from one of the main sections of ICD-9 that explains the nature of the patient's condition.

• Use an E code(s) after any code in the range of 001-V89, indicating an injury, poisoning, or adverse effect due to an external cause. "I can't think of a situation when you would not sequence the E code last," says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC.

V codes serve another function: They document encounters for circumstances other than a disease or injury, such as prophylactic care or counseling on health related issues. According to ICD-9 guidelines, "V codes indicate a reason for an encounter ... A corresponding procedure code must accompany a V code to describe the procedure performed."

As an orthopedic coder, you primarily rely on V codes to report:

• aftercare following cast changes or fracture care, such as V53.7 (Orthopedic devices), V54.1x (Aftercare for healing traumatic fracture), or V54.2x (Aftercare for healing pathologic fracture).

• circumstances or problems that influence a patient's health status but are not the current illness or injury. These can include a range of diagnoses such as V43.6x (Organ or tissue replaced by other means ...) for joint replacement status, V45.4 (Arthrodesis status), V54.01 (Encounter for removal of internal fixation device), V54.89 (Other orthopedic aftercare), or V58.41 (Encounter for planned post-operative wound closure).

"I think the big difference is that E codes are going to explain how the injury occurred and where, especially for orthopedics," says Sandy Swartz, central business office manager for Sturgis Medical Group in Sturgis, Mich. "The V codes explain why the patient is returning to the office after the initial injury."

Example: A patient was injured while riding a motorcycle. "He had an ORIF due to non-compliance (walking on his leg)," Swartz says. "He bent the rod and had to return to the OR."

To paint the full story, Swartz reported two supplementary codes:

• the V code for the non-compliance issue

• the E code for the original accident.

Caution: Before using E codes determine whether the payer accepts E codes, Stout advises. "Most of my clients report these to workers' comp, but few other payers."