Icd 10 code for left hip replacement aftercare

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.

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.

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  • LW Consulting, Inc. (LWCI) can provide customized training for your IDT on the ICD-10 coding, MDS training and PDPM accuracy documentation and decisions.


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
Code Z47.1 (aftercare following joint replacement surgery) is used during the follow-up phase of any joint replacement surgery, even if the replacement was for treatment of a fracture. It must be accompanied by a code from subcategory Z96.6, which identifies the specific joint location and laterality (Table 1).

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:

  • Z47.1—Aftercare following joint replacement surgery
  • Z96.641—Presence of right artificial hip joint

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:

  • Z09—Encounter for follow-up examination for conditions other than malignant neoplasm
  • Z96.641—Presence of right artificial hip joint

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
Code Z47.2 (encounter for removal of internal fixation device) is reported when asymptomatic hardware, used initially to treat a condition that was not an injury or fracture, is removed following completed treatment. This code may not be used very often, because asymptomatic hardware is rarely removed.

If a problem with internal fixation exists, one of the following hardware complication codes would be reported:

  • T84.84—Pain due to internal orthopaedic prosthetic devices, implants, and grafts
  • T84.1 or T84.2—Mechanical complication of internal fixation of limb including breakdown, displacement, or other mechanical complication
  • T84.6—Infection and inflammatory reaction due to internal fixation device

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:

  • Adjustment of internal fixation for fracture treatment (use fracture code with 7th character for active treatment)
  • Removal of internal or external fixator when used to treat a fracture or injury (use fracture code with 7th character extension indicating routine healing

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:

  • Z47.31—Following explantation of shoulder joint prosthesis
  • Z47.32—Following explantation of hip joint prosthesis
  • Z47.33—Following explantation of knee joint prosthesis

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
Codes for aftercare following surgical amputation and aftercare following scoliosis surgery are new categories in ICD-10-CM.

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
Payers are currently on "edit light" for ICD-10-CM codes on claims, and predicting how they will follow the ICD-10 guidelines for aftercare is difficult. Previously (under ICD-9), payers requested the use of the surgical diagnosis in the global period, even though orthopaedic aftercare codes existed with guidelines similar to those in ICD-10.

To identify payer coding preference, take the following steps when reporting orthopaedic aftercare:

  • Follow the ICD-10-CM guidelines for reporting orthopaedic aftercare.
  • Watch for rejections or delays based on reporting of Z aftercare codes as payers "turn up the heat" on claim edits.
  • Following any rejection or delay, query payers for their preferred reporting method for orthopaedic aftercare.
  • Appeal claims that have inappropriate rejections and resubmit the claim with the payer's preferred code. Identify and track patterns. If payers play by the rules outlined in ICD-10-CM, there will be smooth sailing for claims through the rough seas of reimbursement.

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 ICD

ICD-10: Z47. 1, Aftercare following surgery for joint replacement.

What is the ICD

Aftercare 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 ICD

ICD-10 Code for Presence of artificial hip joint- Z96. 64- Codify by AAPC.