Coding of Total Joint Procedures

8/14/2019 Coding of Total Joint Procedures

1/20

Coding of Total Joint ProceduresUpdate 2009

Duke Hip and Knee ConferenceDuke Hip and Knee Conference

David E. Attarian, M.D., F.A.C.S.David E. Attarian, M.D., F.A.C.S.


2/20

ICD-9-CM

International Classification of Diseases, 9International Classification of Diseases, 9 thth

Revision, Clinical Modification- publishedRevision, Clinical Modification- published

under different names since 1900.under different names since 1900.

A statistical classification system arrangingA statistical classification system arranging

diseases and injuries into groups; reviseddiseases and injuries into groups; revised

about every 10 years by the World Healthabout every 10 years by the World Health

Organization. Adopted by CMS.Organization. Adopted by CMS.

Currently about 14,000 codesCurrently about 14,000 codes


3/20

ICD-9-CM

In the 1950s, U.S. Public Health ServiceIn the 1950s, U.S. Public Health Service

and Veterans Administration adoptedand Veterans Administration adopted

classification system for hospital indexingclassification system for hospital indexing

purposes. Other hospital systems followed.purposes. Other hospital systems followed. The Medicare Catastrophic Coverage Act ofThe Medicare Catastrophic Coverage Act of

1988 mandated that ICD-9-CM codes be1988 mandated that ICD-9-CM codes be

used for billing beginning April 1, 1989.used for billing beginning April 1, 1989.


4/20

CMS Requirements Uniform Health Insurance Claim Form, CMS1500, must listUniform Health Insurance Claim Form, CMS1500, must list

at least one but no more than four ICD-9-CM codes perat least one but no more than four ICD-9-CM codes perencounter or service.encounter or service.

Submit the most specific code possible, 3 to 5 digits.Submit the most specific code possible, 3 to 5 digits.

Failure to use ICD-9-CM codes may be punished with finesFailure to use ICD-9-CM codes may be punished with fines

of $2000 per claim or prevention from participation inof $2000 per claim or prevention from participation inMedicare for up to 5 years.Medicare for up to 5 years.

ICD-10-CM will be mandated by CMS (then all payors mustICD-10-CM will be mandated by CMS (then all payors mustfollow) on October 1, 2013. Has 68,100 codes, 3 to 7 digits.follow) on October 1, 2013. Has 68,100 codes, 3 to 7 digits.

Supports quality and P4P reporting.Supports quality and P4P reporting. Upgraded Health Insurance Portability and AcountabilityUpgraded Health Insurance Portability and Acountability

requirements (4010 to 5010) starts 2010 and required inrequirements (4010 to 5010) starts 2010 and required in2012.2012.


5/20

Diseases of the Musculoskeletal

System and Connective Tissue

710-730 Most common for total joints-Most common for total joints-

osteoarthrosis 715, crystal arthropathiesosteoarthrosis 715, crystal arthropathies712, and rheumatoid arthritis 714.712, and rheumatoid arthritis 714.

Primary osteoarthrosis of hip- 715.15Primary osteoarthrosis of hip- 715.15

Generalized osteoarthosis involving knee-Generalized osteoarthosis involving knee-715.06715.06


6/20

Complications of Surgical and

Medical Care, Not ElsewhereClassified

Infected joint prosthesis- 996.66Infected joint prosthesis- 996.66 Mechanical complication of internalMechanical complication of internal

orthopaedic device, implant, or graft- 996.4orthopaedic device, implant, or graft- 996.4


7/20

New Codes

996.41- mechanical loosening of prosthetic996.41- mechanical loosening of prosthetic

jointjoint

996.42- dislocation of prosthetic joint996.42- dislocation of prosthetic joint

996.43- prosthetic joint implant failure or996.43- prosthetic joint implant failure or

breakagebreakage

996.44- periprosthestic fracture around996.44- periprosthestic fracture around

prosthetic jointprosthetic joint


8/20

New Codes

996.45- periprosthetic osteolysis996.45- periprosthetic osteolysis

996.46- articular bearing surface wear of996.46- articular bearing surface wear of

prosthetic jointprosthetic joint

996.47- other mechanical complication of996.47- other mechanical complication of

prosthetic joint implantprosthetic joint implant

996.48- bone graft failure996.48- bone graft failure


9/20

DRG(Diagnosis- Related Group)

Updates Formerly DRG 209- all hip/ knee arthoplastyFormerly DRG 209- all hip/ knee arthoplasty

Changes October 2005-Changes October 2005-

DRG 544- primary hip/ knee arthroplastyDRG 544- primary hip/ knee arthroplasty DRG 545- revision hip/ knee arthroplastyDRG 545- revision hip/ knee arthroplasty

Changes October 2007Changes October 2007

MS-DRG- MCC, CC, or without MCC/CCMS-DRG- MCC, CC, or without MCC/CC HHS developed ICD-10 PCS for hospitals.HHS developed ICD-10 PCS for hospitals.


10/20

CPT- Current Procedural

Terminology (AMA-1966) Systematic listing and coding of procedures andSystematic listing and coding of procedures and

services performed by physicians.services performed by physicians.

Each procedure or service has a 5 digit code.Each procedure or service has a 5 digit code. Service must be supported by an appropriate ICD-Service must be supported by an appropriate ICD-

9-CM code.9-CM code. Musculoskeletal System 20000- 29999Musculoskeletal System 20000- 29999

Updated annually (October for coming year)Updated annually (October for coming year) Relative Value Units (RVU) assigned to eachRelative Value Units (RVU) assigned to each

CPT.CPT.


11/20

Old Hip Arthroplasty Codes (I) 27125- hemiarthroplasty27125- hemiarthroplasty

27236 hemiarthroplasty for fracture27236 hemiarthroplasty for fracture

27130- total hip with/ without bone graft27130- total hip with/ without bone graft

27132- conversion of previous hip surgery to total hip arthroplasty27132- conversion of previous hip surgery to total hip arthroplasty

27134- revision total hip, both components, with/ without bone27134- revision total hip, both components, with/ without bonegraftgraft

27137- hip revision, acetabulum only27137- hip revision, acetabulum only 27138- hip revision, femur only27138- hip revision, femur only

27090- removal of hip prosthesis27090- removal of hip prosthesis

27091- complicated removal of hip prosthesis, cement, with/27091- complicated removal of hip prosthesis, cement, with/without insertion of spacerwithout insertion of spacer

27299- unlisted procedure/? resurfacing27299- unlisted procedure/? resurfacing


12/20

New Codes

00.70- revision both components00.70- revision both components 00.71- revision acetabular component +00.71- revision acetabular component +

femoral headfemoral head 00.72- revision femoral component +00.72- revision femoral component +

acetabular lineracetabular liner

00.73- isolated revision of head + liner00.73- isolated revision of head + liner 84.56- insertion of cement spacer84.56- insertion of cement spacer 84.57- removal of cement spacer84.57- removal of cement spacer


13/20

Old Knee Arthroplasty Codes

27438- patellar prosthesis27438- patellar prosthesis

27445- knee hinge prosthesis27445- knee hinge prosthesis

27446- unicompartmental arthroplasty27446- unicompartmental arthroplasty

27447- total knee with/ without patellar27447- total knee with/ without patellar

resurfacingresurfacing

27486- revision, one component27486- revision, one component

27487- revision, femur and tibial components27487- revision, femur and tibial components

27488- removal of prosthesis, with/ without27488- removal of prosthesis, with/ withoutinsertion spacerinsertion spacer

27599- unlisted procedure27599- unlisted procedure


14/20

New Codes

00.80- revision of all components00.80- revision of all components

00.81- revision of tibial component/ insert00.81- revision of tibial component/ insert

00.82- revision of femoral component00.82- revision of femoral component 00.83- revision of patellar component00.83- revision of patellar component

00.84- isolated revision of tibial insert00.84- isolated revision of tibial insert

84.56- insertion of cement spacer84.56- insertion of cement spacer 84.57- removal of cement spacer84.57- removal of cement spacer

Ph i i Q lit R ti I iti ti


15/20

Physician Quality Reporting Initiative-

PQRI (Medicare Improvement for

Patients and Providers Act (MIPAA) Timing of antibiotics- 4047F (ordered)Timing of antibiotics- 4047F (ordered)

4048F(given)4048F(given)

Selection of antibiotic- 4041F (ordered/given)Selection of antibiotic- 4041F (ordered/given) Discontinuation of antibiotics- 4049F (ordered)Discontinuation of antibiotics- 4049F (ordered)

VTE prophylaxis- 4044F (ordered/given)VTE prophylaxis- 4044F (ordered/given)

1.5% bonus 2007/2008, 2% bonus 2009 by1.5% bonus 2007/2008, 2% bonus 2009 byreporting 3 out 4 quality measures on 80%reporting 3 out 4 quality measures on 80%

eligible Medicare patients (provider or group)eligible Medicare patients (provider or group)


16/20

Modifiers

-51- bilateral-51- bilateral -53- discontinued after starting-53- discontinued after starting

-58- staged or related during global period-58- staged or related during global period

-59- distinct procedural service-59- distinct procedural service -78- return to OR for related procedure-78- return to OR for related procedure

-79- return to OR for unrelated procedure-79- return to OR for unrelated procedure

-80- assistant surgeon-80- assistant surgeon

-22- unusual/ extraordinary work effort-22- unusual/ extraordinary work effort


17/20

T codes- Emerging Technology ( III)

Computer Assisted Surgery Primary CPT+Primary CPT+

0054T*- CAS based fluoroscopic images0054T*- CAS based fluoroscopic images 0055T*- CAS based CT or MRI images0055T*- CAS based CT or MRI images

0056T*- CAS based imageless technology0056T*- CAS based imageless technology

Had CPT in 2008; recycled to III in 2009*Had CPT in 2008; recycled to III in 2009* Reimbursement is variable/ payor dependent.Reimbursement is variable/ payor dependent.


18/20

Examples

Bilateral total knees for osteoarthritis-Bilateral total knees for osteoarthritis-715.16/ 27447.50715.16/ 27447.50

Return to OR for hip revision secondary toReturn to OR for hip revision secondary to

recurrent dislocation during global period-recurrent dislocation during global period-996.42/ 00.71.78 (acetabulum/femoral996.42/ 00.71.78 (acetabulum/femoralhead)head)

Unspecified codes- e.g. hip resurfacingUnspecified codes- e.g. hip resurfacing Coders must also indicate place of serviceCoders must also indicate place of service

and inpatient/ outpatient status.and inpatient/ outpatient status.


19/20

Examples

2 stage knee revision in a global period: 274882 stage knee revision in a global period: 27488for removal/spacer; 27447-58,22 forfor removal/spacer; 27447-58,22 for

reimplantationreimplantation

22ndnd stage reimplantation from another surgeon:stage reimplantation from another surgeon:27447-22, and removal of drug non27447-22, and removal of drug nonbiodegradable implant, 11982.51.biodegradable implant, 11982.51.

22ndnd stage reimplant total hip/remove spacerstage reimplant total hip/remove spaceroutside global period: 27132-22outside global period: 27132-22


20/20

Recommendations Become intimately familiar with ICD-9-CM and CPTBecome intimately familiar with ICD-9-CM and CPT

books/ update programs or books each yearbooks/ update programs or books each year New training will be needed in advance of ICD-10-CMNew training will be needed in advance of ICD-10-CM

implementationimplementation Take a coding course at least once (AAOS or AMATake a coding course at least once (AAOS or AMA

sponsored).sponsored). Always code correctly and ethically; document service inAlways code correctly and ethically; document service in

medical record. Coding must match record exactly. Codingmedical record. Coding must match record exactly. Codingmistakes can be interpreted as fraud (which is a felonymistakes can be interpreted as fraud (which is a felony

punishable by fine, loss of payor privilege, and/orpunishable by fine, loss of payor privilege, and/or

imprisonment).imprisonment). Use professional coders or coding service; Duke hasUse professional coders or coding service; Duke has

PRMO.PRMO.

Coding of Total Joint Procedures

Documents

Transcript of Coding of Total Joint Procedures