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Periprosthetic fractures ICD-10
I'm new to coding ortho and I am very confused on how to code periprosthetic fractures. I was under the impression that only one ICD-10 was required for this type of fracture (M97.x). What am I missing?
Question:
I'm new to coding ortho and I am very confused on how to code periprosthetic fractures. I was under the impression that only one ICD-10 was required for this type of fracture (M97.x). What am I missing?
Answer:
There is a category of codes in ICD-10, specific to Periprosthetic fractures around internal prosthetic joints, and the category is M97. When referring to the tabular section of ICD-10, under M97 category there is an instructional note which states the following: code first, if known, the specific type and cause of the fracture. That being said, if the documentation reflects the site and type of fracture while also identifying this as a periprosthetic fracture around an internal prosthetic joint, you will assign the primary ICD-10 code for the known fracture, followed by ICD-10 from M97 series to identify the periprosthetic fracture for the specific joint.
Example: Displaced comminuted periprosthetic fracture of the proximal shaft of the right femur, patient status post right total hip replacement.
ICD-10 codes:
1) S72.351A
2) M97.01XA
Let's take this one step further, according to ICD-10, if you have a periprosthetic fracture around a prosthetic joint in which there is no specific code, then you would report M97.8XX-, and then use an additional ICD-10 code to identify the joint Z96.6-. The ICD 10 instructions for M97 instruct to code first, if known, the specific type and cause (e.g. pathologic or traumatic). If you read on to M97.8, there are additional instructions to also report the appropriate joint (Z96.6-). As you can see, the instructions and hierarchy are a bit different when there is a specific joint arthroplasty code versus not.
Example: Displaced comminuted periprosthetic fracture of the right distal radial shaft, patient status post right wrist arthroplasty.
ICD-10 codes:
1) S52.351A
2) M97.8XXA
3) Z96.631
*This response is based on the best information available as of 12/19/24.
Ear Hairs
Ear hair(s) are not considered foreign bodies as they are a natural protectant to the inner ear and function to work with earwax to keep the canal clean and debris away from the eardrum.
Question:
If a patient comes in with ear pain due to loose ear hairs in the ear and the provider removes the hairs with alligator forceps, can it be billed as a foreign body removal?
Answer:
Ear hair(s) are not considered foreign bodies as they are a natural protectant to the inner ear and function to work with earwax to keep the canal clean and debris away from the eardrum.
As such, even though the hair is loose or dislodged, there is not a reportable CPT code for this. The work for removing the hairs is Included in the work for the E/M service, assuming there was a medical necessity for an E/M service (e.g., evaluation of ear pain).
*This response is based on the best information available as of 12/19/24.
Counting the Number and Complexity of Problems Addressed
Would cervical and lumbar radiculopathy count as one or two problems and are they considered acute or chronic or stable or not stable on the table of risk?
Question:
Would cervical and lumbar radiculopathy count as one or two problems, and are they considered acute, chronic, stable, or not stable on the table of risk?
Answer:
Good questions! First, the number of problems would be two since these are different body parts, and each will require its own diagnosis and treatment recommendation.
The next is issue is, are the presenting problems acute or chronic, and that will require a good history of present illness, detailing how the problem presented. Was it an injury? Is it degenerative, so by the very nature of degenerative disease it is chronic. An accurate selection of where the problems “fit’ within the problem element cannot be determined without a good history.
*This response is based on the best information available as of 12/19/24.
Percutaneous Fracture Fixation
Our surgeon performed a closed reduction of a medial malleolar fracture with percutaneous fixation. There is no documentation of an open reduction, and we are unsure how to report this procedure.
Question:
Our surgeon performed a closed reduction of a medial malleolar fracture with percutaneous fixation. There is no documentation of an open reduction, and we are unsure how to report this procedure.
Answer:
Percutaneous fixation of a medial malleolar fracture is reported with an unlisted code, 27899. Work with your surgeon to identify a comparison code; one option is CPT code 27762 (Closed treatment of medial malleolus fracture with manipulation, with or without skin or skeletal traction).
*This response is based on the best information available as of 12/5/24.
Laparoscopic vs Percutaneous
What is the difference between laparoscopic and percutaneous procedures and how do we choose the correct CPT code for these?
Question:
What is the difference between laparoscopic and percutaneous procedures, and how do we choose the correct CPT code for these?
Answer:
Laparoscopy refers to a flexible tube (laparoscope) inserted via small incisions, typically in the abdominal or pelvic cavity for direct visualization of the body cavity and organs. These CPT codes will have the term “laparoscopic” in their description.
Percutaneous procedures are minimally invasive procedures performed via a puncture or minor small incision with no direct visualization of structures. They are performed with imaging guidance. These CPT codes will have the term “percutaneous” in their code description.
*This response is based on the best information available as of 12/5/24.
Billing an E/M Service after Mohs when a repair is indicated
Our Mohs surgeons sometimes perform an adjacent tissue transfer or a flap after Mohs surgery. Since they decided to do the flap after Mohs, they want to bill an E/M service with Modifier 57. I don’t think this is correct. Can you help clarify?
Question:
Our Mohs surgeons sometimes perform an adjacent tissue transfer or a flap after Mohs surgery. Since they decided to do the flap after Mohs, they want to bill an E/M service with Modifier 57. I don’t think this is correct. Can you help clarify?
Answer:
The E/M service should not be reported after Mohs surgery when a decision is made for a repair, flap, or graft. Even though a flap has a 90-day global period, the surgical decision was made to perform Mohs, the primary procedure. The intent of the E/M with Modifier 57 for a procedure with a 90 global period is when the initial decision is made to perform the primary procedure. The repair is secondary; therefore, billing an E/M service is inappropriate. The discussion and recommendation for the repair is part of the pre-service work for the repair and the E/M service is inherent to the procedure.
CMS Global Surgery Workbook says: “When the decision to perform the minor procedure comes immediately before a major procedure or service, we consider it a routine pre-operative service and you can’t bill a visit or consultation with the procedure. MACs may not pay for an E/M service billed with CPT modifier –57 if it’s provided on the day of, or the day before, a procedure with a 000- or 010-day global surgical period. “
Source: https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf
*This response is based on the best information available as of 12/5/24.
