Orthopedics

1
Chapter 8

• Orthopedics

2
Orthopedic Diagnoses

• Most of the diagnosis codes fall into the
  Diseases of the Musculoskeletal System and
  Connective Tissue (710739) chapter of ICD-9.
• E codes are necessary to describe accidents,
  injuries, and place of occurrence.

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Fractures
4
Fractures (cont.)

• Open broken bone punctures skin
• Compound
• Infected
• Missile
• Puncture
• With foreign body

5
Fractures (cont.)

• Closed no puncture through the skin
• Comminuted
• Depressed
• Fissured
• Greenstick
• Spiral
• Impacted

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Fracture Coding

• Identify the site of the fracture.
• Determine fracture type open or closed.
• Assign appropriate E codes.
• Assign CPT code from musculoskeletal section.
• Assign code for wound debridement, if necessary.

7
Pathological Fracture

• Fracture obtained from diseased bone without any
  identifiable trauma or following only minor
  trauma
• Words pathologic or spontaneous must be
  present
• Category 733.1x. Fifth digit identifies the site.

8
Fracture Treatments

• Reduction
• Aligning fractured bones and bone fragments back
  into their normal anatomical alignment
• Open
• Closed

9
Fracture Treatments (cont.)

• Fixation
• Fractured bones are secured into their normal
  anatomical alignment.
• Internal
• External

10
Fracture Treatments (cont.)

• Surgical
• Open reduction with internal fixation (ORIF),
  external fixation, reduction
• Nonsurgical
• Casting, taping, splinting, traction, bandaging

11
CPT Coding

• Multiple codes can be assigned for procedures.
• Watch for code descriptions with words each,
  single, one, each additional.
• Determine if procedure is done with or without
  anesthesia.
• Pay attention to the code description!

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CPT Surgical Package

• Local infiltration, digital blocks, topical
  anesthesia
• E/M encounter day immediately prior or day of
  procedure
• Immediate post-op care discussion with family

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CPT Surgical Package (cont.)

• Writing orders
• Evaluating patient in recovery area
• Usual post-op follow-up care

14
Dislocations

• Synonymous with luxation
• Subluxation
• Incomplete dislocation

15
Dislocations (cont.)

• Coding tips
• If dislocation is associated with a fracture of
  the same site, only the fracture code is
  assigned.
• If dislocation and fracture of different but
  related sites is present, code both.

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Arthropathy

• Diagnoses
• Infective arthropathy
• Rheumatoid arthropathy
• Degenerative arthritis
• Internal derangements

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Arthropathy (cont.)

• Procedures
• Arthrotomy
• Arthroscopy
• Biopsy
• Arthrodesis

• Arthroplasty
• Replacement
• Revision

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Arthroscopic CPT Codes

• All arthroscopic and endoscopic codes include
• Diagnostic arthroscopy
• Minor synovectomy
• Removal of loose bodies
• Evacuation of debris
• Splinting or casting

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Arthroscopic CPT Codes (cont.)

• Coding tips
• There are rules for when a procedure is converted
  from endoscopic to open.
• Must check the CCI edits to avoid unbundling

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Vertebrae

• Disorders
• Myelopathy
• Enthesopathy
• Spondylarthritis
• Spondylosis
• Radiculitis
• Radiculopathy

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Vertebrae (cont.)

• Procedures
• Decompression of nerves
• Excision vertebral disk (laminectomy/ laminotomy)
• Spinal fusion (arthrodesis)
• Epidural injections

22
Sprains and Strains

• Sprain
• Severe stretching of ligament with minor tears
  and hemorrhage, without subluxation, dislocation,
  or fracture
• Strain
• Soft tissue injury that occurs from overexertion

23
Malunion

• Properly or improperly treated with deformed
  alignment
• Did not heal in proper anatomical alignment

24
Nonunion

• Incompletely healed bone
• Failure to heal even with proper treatment

25
Bone Infection

• Acute or chronic osteomyelitis
• Caused by bacteria, complications from implants,
  open fractures, foreign bodies
• Periostitis

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Bone Infection (cont.)

• Common procedures
• Sequestrectomy (excision of bone)
• Bone biopsy
• Bone grafts