Changes of Particular Importance to Orthopedic Practices

  • The orthopedic section of codes is expanding more than any other section of the new code sets. For example, in describing a diagnosis of adhesive capsulitis of the shoulder, ICD-9 had just one code (726.0). ICD-10 has three codes—adhesive capsulitis of unspecified shoulder (M75.00), adhesive capsulitis of right shoulder (M75.01), and adhesive capsulitis of left shoulder (M75.02).
  • With the implementation of ICD-10, which utilizes lateral specific diagnosis (left, right, upper, lower, etc) many payors have already indicated they will deny claims that don’t specify laterality. In the example above M75.00 would be denied, while M75.01 and M75.02 would pay.
  • Training is especially important to familiarize ourselves with these new significant changes. Orthopedic practices may have a more challenging time with ICD-10 when it comes to Medicare. Orthopedic treatment for many Medicare patients often includes the use of durable medical equipment (DME), in addition to physician services. For example, patients who have knee surgery and require ongoing therapy may take home a TENS machine or other DME equipment.
  • This equipment is billed differently than physician services. Therefore, orthopedic offices and staff will need to submit ICD-10 codes for both Medicare Part A and Part B claims.

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