All health care providers are required to move from ICD-9 to ICD-10 sometime after October 1, 2015. ICD-10 will replace and update the current ICD-9 system and has two parts as follows:
- ICD-10-CM: For medical diagnosis and description of symptoms and
- ICD-10-PCS: For procedures concerning inpatient hospital settings
Several problems that were found in ICD-9-CM have been addressed in ICD-10-CM. This helps the billing process and provides enhanced information for clinical decision-making, and research. ICD-10 updates the medical industry with the new advancements in patient care and has added several new disease classifications and terminologies to be consistent with modern day medical service usage. A subset of codes is used to specify more details about the diagnosis and procedure site.
Comparison of ICD-9 to ICD-10
The 5 digit codes used in ICD-9 lack some specification of information. For example, if an orthopedic patient is seen for a fracture on the right arm, the ICD-9 diagnosis code does not specify that the fracture is on the right arm. A modifier code had to be included to designate the affected side. In the ICD-10 diagnosis code set, additional characters are used to allow identification of right and left arm, simplifying the process of billing by reducing paper work.
ICD-10 is also more flexible as the code structure allows for a much higher level of detail which may make the job of the orthopedic doctors, administrators and billing personnel easier. The added details in the coding structure may also improve the ability to measure health care services.
Bill and code orthopedic medical services in ICD-10
All involved in medical billing and coding need to upgrade their knowledge and billing systems to comply with ICD-10. The ICD-10-PCS is the coding system that will replace ICD-9-CM Volume 3, which involves inpatient procedures. ICD-10-PCS covers disease prevention, identification of diagnosis, treatment plans and case management. There are 87,000 codes in ICD-10 as compared to the 14,000 in ICD-9-CM.
No More Bone Graft Confusion
Bone graft procedures that are common in orthopedics often present volumes of confusion for billers/coders working with ICD-9. ICD-10 allows in-depth details on bone graft diagnosis and procedure including structural support, correction of deformities, and reconstruction.
List of Orthopedic Codes ICD-10:
- M00-M02 - Infectious Arthropathies
- M05-M14 - Inflammatory Polyarthropathies
- M15-M19 - Osteoarthritis
- M20-M25 - Other Joint Disorders
- M26-M27 - Dentofacial Anomalies [Including Malocclusion] and Other Disorders of Jaw
- M30-M36 - Systemic Connective Tissue Disorders
- M40-M43 - Deforming Dorsopathies
- M45-M49 - Spondylopathies
- M50-M54 - Other Dorsopathies
- M60-M63 - Disorders of Muscles
- M65-M67 - Disorders of Synovium and Tendon
- M70-M79 - Other Soft Tissue Disorders
- M80-M85 - Disorders of Bone Density and Structure
- M86-M90 - Other Osteopathies
- M91-M94 - Chondropathies
- M95 - Other Disorders of the Musculoskeletal System and Connective Tissue
- M96 - Intraoperative and Postprocedural Complications and Disorders Of Musculoskeletal System, Not Elsewhere Classified
- M99 - Biomechanical lesions, not elsewhere classified
ICD-9-CM Diagnoses Codes are 3 – 5 digits with the first digit being alpha (E or V) or numeric and Digits 2 – 5 being numeric e.g., 496 for chronic airway obstruction and V02.61 for Hepatitis B carrier.
ICD-10-CM Diagnoses Codes are much more consistent with 3 – 7 digits where digit 1 is Alpha, digit 2 is numeric and Digits 3 – 7 are alpha or numeric, e.g., A78 – Q for fever and S52.131a for displaced fracture of neck of right radius, initial encounter for closed fracture.
With the increased number and specificity of codes under ICD-10, physicians are going to have to be more specific in their patient encounter documentation to provide the coders the best opportunity to choose the most correct codes for the most appropriate reimbursement.