Wiki Dx question 996.47 - ortho

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k-jag

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Diagnosis coding Kings and Queens -- your opinions please!

What diagnosis code(s) (not CPT's) would you report at an office visit following the patient's acute hospitalization for this scenario (let's assume there is no global period at the time of this office visit):

Patient has had a total knee replacement in the past. While hunting he accidentally shoots himself in the femur just above the knee prosthesis, causing an open fracture and he undergoes plate fixation, etc., by different MD. After the acute inpatient stay he goes for an office visit with an orthopedic surgeon who recommends revising/replacing the damaged total knee prosthesis.

The orthopedic surgeon wants to report 996.47 (Other Mechanical Complication of Prosthetic Joint Implant; Mechanical Complication of Prosthetic Joint NOS; Prosthetic Joint Implant Failure NOS.) Is code 996.47 only used when there is a mechanical failure of the device itself, such as defective design, manufacturing, etc.? The patient definitely has a problem with the knee implant, but it's due to external causes and not due to an inherent defect of the device itself.

Thanks for any direction you have on this.
 
k-jag said:
Diagnosis coding Kings and Queens -- your opinions please!

What diagnosis code(s) (not CPT's) would you report at an office visit following the patient's acute hospitalization for this scenario (let's assume there is no global period at the time of this office visit):

Patient has had a total knee replacement in the past. While hunting he accidentally shoots himself in the femur just above the knee prosthesis, causing an open fracture and he undergoes plate fixation, etc., by different MD. After the acute inpatient stay he goes for an office visit with an orthopedic surgeon who recommends revising/replacing the damaged total knee prosthesis.

The orthopedic surgeon wants to report 996.47 (Other Mechanical Complication of Prosthetic Joint Implant; Mechanical Complication of Prosthetic Joint NOS; Prosthetic Joint Implant Failure NOS.) Is code 996.47 only used when there is a mechanical failure of the device itself, such as defective design, manufacturing, etc.? The patient definitely has a problem with the knee implant, but it's due to external causes and not due to an inherent defect of the device itself.

Thanks for any direction you have on this.
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I would use the 996.47 it is still a mechanical complication of prosthetic joint - it is not specific to defective implant - it is not indicating "how" - your external cause would be reported with E codes.
 
i would recommend not using a code for mechancal complication for the simple reason that therebis not mechanical issue here. The prothesis is broken/ damaged due to an injury not as a complication of the device. I use a code ofr the pain due to truama if it is documented and a late effect of the injury from 905 - 908 section.
 
As Michellde stated the mechanical part was broken because of the shooting. You would code the accident ICD 9 code not the mechanical code.
 
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