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Fracture Coding CM and PCS
Here are some examples of valid ICD-10-PCS codes using the approach values: 0QSG0ZZ - Open fracture reduction right tibia 0BT60ZZ - Open biopsy of lung 3E0G3ZZ - Percutaneous biopsy of liver 4A023Z3 - Arthroscopy of right knee with meniscectomy 7A15223 - Foley catheter insertion into bladder 8A1D00Z - Colonoscopy F1A50ZZ - Laparoscopic assisted vaginal hysterectomy XGA00ZZ - Application of lower extremity cast
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Similar to Fracture Coding CM and PCS
Fracture Coding CM and PCS
- 1. ICD-10-CM and ICD-10-PCS Fracture Coding Char Gore, RHIA, CCS Kim Lee, RHIA, CCS-P, CPC
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- 3. Abbreviations - General • CC = chief complaint • DS = discharge summary • DX = diagnosis • H&P = history and physical • PE = physical exam • PMH = past medical history • ROS = review of systems
- 4. Abbreviations - Orthopedic • FX = fracture • C1-C7 = cervical vertebrae • DIP = distal interphalangeal (joint) • L1-L5 = lumbar vertebrae • LLE = left lower extremity • LUE = left upper extremity • RLE = right lower extremity • RLU = right upper extremity
- 5. • ORIF = Open reduction and internal fixation • PIP = proximal interphalagenal (joint) • ROM = range of motion • S1 = first sacral vertebra • T1-T12 = thoracic vertebrae • THR = total hip replacement • Tib-fib = tibia-fibula
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- 33. FRACTURES • Open • Hairline • Closed • Displaced • Colles • Nondisplaced • Comminuted • Oblique • Compression • Spiral • Depressed • Transverse • Greenstick
- 34. Open Vs. Closed Open Closed Bone breaks through the Bone does not break through overlying skin the overlying skin
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- 36. Comminuted Bone crushed into several pieces
- 37. Compression Vertebrae Could be compressed traumatic (from a together. fall on the buttocks) or pathologic (due to disease where it collapses on itself)
- 38. Depressed Inward fracture
- 39. Greenstick Broken on onlyone side. Common in children
- 40. Hairline Very thin – bone pieces still together
- 41. Displaced and Nondisplaced Non displaced = normal alignment Displaced = pulled out of normal alignment
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- 43. Spiral Due to atwisting force
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- 52. Non displaced andDisplaced
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- 57. ICD-10-CM Brief Overview Taking what you know in 9 and applying it to 10
- 58. Snapshot of thesystems ICD-9-CM ICD-10-CM • Numeric • Alphanumeric • 3 to 5 digits • 3 to 7 characters • 3 digits then a decimal • 3 characters then a decimal • Covered Chapter 17 • Covered chapter 19 – 486 Pneumonia, NOS – J18.9 Pneumonia, NOS – 401.9 HTN, NOS – I10 Essential HTN – 034.0 Strep sore throat – J02.0 Strep pharyngitis Official Coding Guidelines Conventions and General Guidelines are very similar – instructional notes, manifestation of disease coding, sequencing
- 59. Basically the same •Assign separate codes for each injury • Most serious injury sequenced first – Most serious FX sequenced first if multiple • FX not indicated as open or closed = closed • Still required – External Cause – Place of occurrence – Activity – Status • We just don’t call these E-codes anymore – they are V-Y
- 60. New Guidelines • FXnot indicated as displaced or not displaced = displaced (displaced does not = open). • FX code includes info to indicate which encounter this is – Aftercare is now included in the ICD-10-CM diagnosis code (in I-9 we used a V code) – Late effects now called sequela. There is one combination code that includes both the sequela and the original fracture.
- 61. Three Big Differencesin Orthopedic diagnosis codes Laterality 7th character • Right side / Left side • Type of Fracture (open/closed) Specificity • Initial Encounter / subsequent encounter • Type of fractures • Reason for subsequent – Greenstick encounter – Transverse – Delayed healing – Spiral – Nonunion, malunion – oblique • Sequela (late effect)
- 62. Laterality Fracture of the fifth metatarsal bone of the left foot ICD-9-CM ICD-10-CM 825.25 Fracture, Closed S92.352- Displaced fracture of metatarsal bone(s) fifth metatarsal bone, left foot No code for fifth metatarsal *also need 7th character to explain encounter
- 63. Specificity to FractureType Greenstick Fracture of the Right Radial Shaft ICD-9-CM ICD-10-CM 813.21 Fracture, Shaft, Radius S52.311- Greenstick Fracture alone of shaft of radius, right arm *also requires a seventh character to No code for “greenstick denote encounter fracture” – just codes to radial shaft
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- 65. Initial Encounters ICD-9-CM ICD-10-CM • Fracture fifth metatarsal • Fracture fifth metatarsal bone left foot bone left foot – 825.25 Fracture, Closed – S92.352A Displaced fracture metatarsal bone(s) of fifth metatarsal bone, left foot, initial encounter • Greenstick Fracture Right • Greenstick Fracture Right Radial Shaft Radial Shaft – S52.311A Greenstick Fracture – 813.21 Fracture, Shaft, Radius of shaft of radius, right alone arm, initial encounter
- 66. Malunion Malunion ofa previously displaced transverse fracture of the shaft of the right femur ICD-9-CM ICD-10-CM 733.81 malunion fracture S72.321P Displaced Transverse fracture of the shaft of the 905.4 Late effect of fracture of right femur, subsequent lower extremities encounter for fracture with malunion
- 67. Encoder Practice Give mesome to look up!
- 68. Getting to Know– ICD-10-PCS • Totally different from ICD-9-CM • How? – Structure – Organization – Expandability
- 69. Other Important Featuresof ICD-10- PCS • Standardized terminology • Specificity • No explicit “NOS” code options • Limited use of “NEC” code options
- 70. Format / Structureof ICD-10-PCS Codes • 7 Characters • Any character can be alpha or numeric • Numerals 0 – 9 used • 24 letters used, A – H, J – N, and P – Z are used – Letters I and O are not used • Decimals are not used • ICD-10-PCS Code 1 2 3 4 5 6 7
- 71. Valid Code ExampleUsing ICD-10-PCS • Open fracture reduction right tibia – 0QSG0ZZ
- 72. Let’s Play AGame!
- 73. Value Approach Definition Examples 0 Open Cutting through skin or mucous membrane and any CABG other body layers necessary to expose the site of ORIF the procedure 3 Percutaneous Entry, by puncture or minor incision, of Needle biopsy of thyroid instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure 4 Percutaneous Endoscopic Entry, by puncture or minor incision, of Arthroscopy instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site AND visualize the site of the procedure 7 Via Natural or Artificial Opening Entry of instrumentation through a natural or Foley catheter artificial external opening to reach the site of the procedure 8 Via Natural or Artificial Opening Entry of instrumentation through a natural or Colonoscopy Endoscopic artificial external opening to reach the site of the procedure AND visualize the site of the procedure F Via Natural or Artificial Opening Entry of instrumentation through a natural or Laproscopic assisted vaginal With Percutaneous Endoscopic artificial external opening and entry, by puncture or hysterectomy Assistance minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure X External Procedures performed directly on the skin or Closed reduction of fracture mucous membrane and procedures performed indirectly by application of external force through
- 74. Let’s Play AnotherGame!
- 75. Coding Fractures UsingICD-1-PCS • Coding Guideline B3.15
- 76. Let’s Play AnotherGame Coding Scenarios • Case 1 • Case 2 • Case 3
- 77. Resources • ICD-10-CM OfficialCoding Guidelines FY11 http://www.cdc.gov/nchs/data/icd10/10cmguide lines2012.pdf • ICD-9-CM Official Coding Guidelines FY11 http://www.cdc.gov/nchs/data/icd9/icdguide10. pdf • Root Operations: Key to Procedure Coding in ICD- 10-PCS, Anne Barta, MSA, RHIA & Ann Zeisset, RHIT, CCS, CCS-P • Microsoft Clip Art
Editor's Notes
- #69 Because ICD-10-PCS has these three characteristics the codeset is able to be complete, flexible, and expandable. All ICD-10-PCS codes contain 7 characters that identify a category of specific information. ICD-10- PCS has a unique code that be assigned for every significant procedure. Each code retains its own unique definition. Codes are not reused in ICD-10-PCS.Expandability is also a characteristic of ICD-10-PCS. Unlike ICD-9 procedure codes that require whole codes to be added each year to account for the changes in technology and new procedures; ICD-10-PCS changes can be made within existing structure because whole codes are not added.
- #70 In ICD-9 you will find procedure codes that use terminology that includes eponyms, such as the name of a procedure named after a doctor, for example Collis Nissen, you will also see acronyms and other common terms such as CABG, or procedures that include the diagnosis in the code such as “wide excision of lesion on lip”. In ICD-10-PCS you will not find procedure names, diagnostic information, or eponyms. Instead each procedure is coded to the root operation that identifies the outcome of the procedure. The use of codes identified by “NOS and NEC” is not an option for “NOS” and limited for “NEC” that is because in ICD-10-PCS each character in the code defines information about the procedure and all 7 characters must contain a specific value from a single row of a table when you build a code. Let’s look at the format and structure of ICD-10-PCS codes.
- #71 The format and structure of ICD-10-PCS code consist of 7 characters, any character can be alpha or numeric, numerals 0 through 9 are used, 24 letters are used, letters I and O are no used so that coders do not become confused with 1 and 0. Decimals are not used. The ICD-10-PCS code is identified like this:1 = The section2 = The body system3 = The root operation4 = The body part5 = The approach6 = The device7 = The qualifierLet’s look at a valid code in ICD-10-PCS
- #72 As you can see on this slide the first three characters are identified by 0QS which is the section, body system, and operation. The last four characters identify the location of the fracture, right tibia, how the procedure was done, in this case it was open and the last two characters represent whether a device was used and other information about the procedure. You always have to have 7 characters in order for the code to be valid in ICD-10-PCS.
- #73 Great job everyone!
- #75 Now this is a jeopardy game so remember your answer must be in the form of “What is”!
- #76 Key words you should note “reposition, insertion, placement” These words will be helpful to know when looking up codes for procedures in ICD-10-PCS
- #77 Okay now we are going to take a look at some case scenarios. Feel free to work in groups!