| Under the Payment-Driven Payment Model (PDPM), the selection of the primary medical diagnosis recorded in the Minimum Data Set (MDS) item I0020B plays a factor in the Medicare Prospective Payment System (PPS) methodology. Show Understanding the International Classification of Diseases (ICD)-10 coding guidelines is one step; figuring out the Centers for Medicare and Medicaid Services (CMS) PDPM ICD-10-CM Mappings Fiscal Year 2021 is another key element for the reimbursement calculation. Assigning ICD-10 codes must be at the highest degree of specificity based on the provider-documented medical records. Records include the history and physical, recent hospital discharge summary, signed physician’s orders, provider consults, progress notes, and pertinent diagnostic reports. It is important to communicate with the provider to ensure that necessary information is documented in the medical record within the assessment look-back period to identify the appropriate diagnosis codes. Let us discuss the coding for major joint replacement conditions. When is it appropriate to use the aftercare ICD-10 Z codes as the primary medical diagnosis in MDS item I0020B? According to the CMS ICD-10-CM Official Guidelines for Coding and Reporting for Fiscal Year 2021, the aftercare Z codes should not be used for aftercare of traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7th character. Here are examples of the difference: Example 1: A patient with severe degenerative osteoarthritis of the right hip, underwent right hip arthroplasty. MDS item I0020B, the primary diagnosis is Z47.1 - Aftercare following joint replacement surgery and MDS item J2310: Hip replacement, partial or total, should be checked. This would fall under the Major Joint Replacement or Spinal Surgery PDPM Clinical Category. Example 2: A patient sustained a right displaced intertrochanteric fracture of the femur from a fall and had a right hip arthroplasty. MDS item I0020B, the primary diagnosis is S72.141D - Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing and MDS item J2310: Hip replacement, partial or total, should be checked. The coding on the MDS would map to the Major Joint Replacement or Spinal Surgery PDPM Clinical Category. If example 2 were incorrectly coded a hip fracture repair, MDS item J2510, this information would map to the Orthopedic PDPM Clinical Category. Refer to the CMS PDPM Mapping for the ICD-10-CM recorded in item I0020B of the MDS Assessment to PDPM Clinical Categories shown below. Note: pay close attention to the fourth column - Default Clinical Category and the fifth column - Resident Had a Major Procedure during the Prior Inpatient Stay that Impacts the SNF Care Plan.
Mapping of the ICD-10-CM Recorded in Item I0020B of the MDS Assessment to PDPM Clinical CategoriesOverviewSort OrderICD-10-CM CodeICD-10-CM Code DescriptionDefault Clinical CategoryResident Had a Major Procedure During the Prior Inpatient Stay that Impacts the SNF Care Plan?43967S72141DDisplaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healingNon-Surgical Orthopedic/MusculoskeletalMaybe Eligible for One of the Two Orthopedic surgery Categories Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM The MDS coding has several elements that affect patient reimbursement classification. Applying the ICD-10 coding guidelines and accurately recording the MDS item(s) under the recent major surgery requiring active SNF care would calculate to the appropriate PDPM Clinical category. How Can LW Consulting, Inc. Help?
If you have questions regarding PDPM, MDS, or other skilled nursing-related policies and procedures, contact Kay Hashagen at (410) 777-5999 or email [email protected]. Z aftercare codes are used in office follow-up situations in which the initial treatment of a disease is complete and the patient requires continued care during the healing or recovery phase or for long-term consequences of the disease. They should not be used to describe the aftercare of traumatic injuries or fractures. In those situations, the 7th character extension should be used because it provides specific information about the healing phase and subsequent care. (For an overview of the 7th character extensions used to describe the phase of treatment of traumatic injuries, see "When 7 Isn't a Lucky Number," AAOS Now, November 2014.) This article focuses on code category Z47, which is used to report orthopaedic aftercare following treatment for a condition or disease, excluding aftercare associated with healing fractures or traumatic injuries. Joint replacement For example, a patient who had a right total hip arthroplasty (THA) to treat severe primary osteoarthritis (OA) has a 6-week follow-up visit. The patient is asymptomatic, the wound is healing nicely, and the prosthesis is in good position without loosening, subsidence, or wear. The patient receives instructions on muscle-strengthening exercises to address a slight limp and is asked to return in 6 weeks. Coding would be as follows:
Another example would be the patient seen 1 year following THA surgery for severe OA, who is asymptomatic with a normal gait, a nicely healed wound, and no signs of loosening, subsidence, or wear. Coding for this visit would be as follows:
This second example uses Z09, which indicates surveillance following completed treatment of a disease, condition, or injury. Its use implies that the condition has been fully treated and no longer exists. Z09 would be used for all annual follow-up exams, provided no complications or symptoms are present. If abnormal pain, inflammation, infection, dislocation, or other mechanical problem is found, the complication code would be reported. Normal postoperative pain or the "slight limp" described in the first example is not assigned an ICD-10 diagnosis code because it is considered routine healing. The diagnosis of primary OA of the right hip is no longer reported because the patient no longer has the condition at that location. If other body areas were evaluated for symptomatic OA on this visit, a diagnosis code would be assigned and the documentation would reflect the evaluation and examination of those areas. As can be seen in Table 1, no specific code exists for toe joint arthroplasty. If a toe joint is replaced, the "other" code (Z96.698) would be reported. Notice that this code does not specify laterality. Three joint locations (hip, knee, and finger) have bilateral codes. All other joint locations (eg, elbow, wrist) in which bilateral implants are present must be reported with two codes, one for the right and one for the left joint. Internal fixation device removal If a problem with internal fixation exists, one of the following hardware complication codes would be reported:
These complication codes can be found in the Injury chapter. When they are used, the 7th character extension is used to report aftercare. ICD-10 guidelines instruct users not to report code Z47.2 in the following situations:
The following three codes are used in staged joint revisions for aftercare following the removal of the prosthesis and as the operative diagnosis when the second stage (reimplantation) is performed:
Note that specific codes are used only for the knee, hip, and shoulder; any other joint locations would be reported with code Z47.89 (encounter for other orthopaedic aftercare). For specifics on reporting the ICD-10 codes for staged joint revision surgery, see "Clean Up Diagnosis Coding for Staged Revisions," AAOS Now, July 2015. Surgical amputations and scoliosis Code Z47.81 (encounter for orthopaedic aftercare following surgical amputation) is used for visits following a surgical amputation and must be accompanied by an additional code that identifies the amputated limb (Table 2). This is not the diagnosis code used to identify the reason (gangrene, tumor, infection, or trauma) for the amputation, but should be used for the care provided after the amputation. Code Z47.82 (encounter for aftercare following scoliosis surgery) is specific to scoliosis surgery. Like total joint replacements, complications would be reported with the codes listed previously for pain, mechanical complications, or infection. For other orthopaedic aftercare following the active treatment of a disease, deformity, or condition that is not the result of an injury, use Z47.89 (encounter for other orthopaedic aftercare). For example, this code would be used for a follow-up visit by a 67-year-old man who underwent reconstruction of a complete nontraumatic rupture of the right rotator cuff. Next steps To identify payer coding preference, take the following steps when reporting orthopaedic aftercare:
Margaret M. Maley, BSN, MS, is a senior consultant with KarenZupko & Associates, Inc., who focuses on CPT and ICD-10 coding education for orthopaedic practices. This article has been reviewed by members of the AAOS Coding, Coverage, and Reimbursement Committee. What is the ICDICD-10: Z47. 1, Aftercare following surgery for joint replacement.
What is the ICDAftercare following joint replacement surgery
Z47. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM Z47. 1 became effective on October 1, 2022.
When do you use Z47 89?Encounter for other orthopedic aftercare
Z47. 89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2023 edition of ICD-10-CM Z47. 89 became effective on October 1, 2022.
What is ICDICD-10 Code for Presence of artificial hip joint- Z96. 64- Codify by AAPC.
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Icd 10 code for left hip replacement aftercare
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