2016 Orthopedic Coding Changes

Medical billing and coding is undergoing a dramatic shift in the United States right now. After years of using the ICD-9 system, and two annual delays, the nation's healthcare system must now finally adopt the new ICD-10 coding system. Used around the world by most other advanced nations, the US is behind the eight ball in using this more advanced system. As a provider of orthopedic services, what orthopedic coding changes can you expect to see in 2016?

A Look Back at 2015

ortho_coding_changes_2016After delaying the implementation of ICD-10 twice, the nation's healthcare system must now begin full use of the ICD-10 coding system already in use around the globe. The Protecting Access to Medicare Act of 2014 delayed the implementation of ICD-10, but now all healthcare providers must shift to the new codes. Orthopedic codes are among one of the many areas impacted by the change.

Becker's ASC Review points out that the shift from the 14,000-code ICD-9 system to the 68,000 code ICD-system won't be easy, but it is now a must for every clinic. Code bundling is among the many trends that impacted healthcare in 2015, meaning that clinics can no longer receive payment on more than one code for each level of pain procedure.

As with other coding changes in 2015, many orthopedic coding changes in 2015 were specific to certain sites or procedures. For example, join injection codes saw three additions and three revisions. This is just one example of many alterations that occurred in 2015.

Orthopedic Coding Changes for 2016

Out with the old and in with the new. ICD-10 is here and clinics across the country are making the transition. The adoption of ICD-10 brings a new batch of challenges for healthcare providers, including those in the field of orthopedics. There are many areas upon which orthopedists should focus with the new ICD-10 orthopedic coding changes, with perhaps the two most important being:

  • Site Specificity
  • Laterality

Within the ICD-10 coding changes there is an immense focus on site specificity. As it relates to orthopedics coding, you'll want to keep the following factors in mind:

  • Regions of the spine: For diagnoses such as spondylosis or spinal stenosis, physicians must document the specific region of the spine and note whether it is occipito-atlanto-axial, cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral, sacral, sacrococcygeal, or some combination of these sites.

  • Osteoporosis with or without a current pathological fracture: Physicians must now document the specific joint, such as the hip, knee, shoulder, elbow, or wrist, and so on.

  • Chronic gout: Again, documentation must specify the site, such as the elbow, writs, hand, hip, ankle, or vertebrae, or multiple sites.

Then there is the case of laterality. In addition to providing site-specific documentation, new orthopedic coding must also site laterality. This means identifying not just the knee or elbow join, but also whether the condition is contained within the right, left, or both joints in that particular site.

Additional changes include documenting the type of encounter, new combination codes, and even place of occurrence codes. Combination codes are rather rare for orthopedic codes in ICD-10, but there are examples that include M54.4, which denotes lumbago with sciatica. The two conditions must be linked and the laterality specified for new coding procedures.

Adjusting to Change in 2016

The best thing you can do for yourself and your practice is take it one step at a time. Conversion to ICD-10 and familiarity with the new orthopedic codes is expected to take most clinics anywhere from six months to a year to feel completely comfortable with the new codes.

HIS is here to help your clinic by providing you with the tools you need to convert smoothly, and adjust to the changes in orthopedic codes for 2016. From educational resources and onsite training, to using our own trained and certified coding experts to handle your coding and billing needs, HIS can provide you with the assistance needed to make the transition easier on your entire staff.