Scenario: A patient comes into an orthopedic office for an injury that has persisted for 5 months. Should your claim include an ICD-10 code for an acute or a chronic injury? On the one hand, the problem has been going on for only 5 months; on the other hand, it has been a steady problem. At what point does an injury switch from being acute to chronic?
If this is a common, vexing question for you, you’re not alone, says coding instructor Margie Vaught in her live audio conference for ProfEdOnDemand. During her presentation on ICD-10 orthopedic coding changes for 2019, Vaught teases out the differences between acute and chronic, so that, instead of getting caught off guard the next time this question arises, you can quickly discern between the two.
3 Signs an Injury is Chronic or Acute
As you well know, coding is a profession that at times seems far simpler on the surface than it actually is. The acute-versus-chronic dilemma is exactly one of those situations that seems like it should have a straightforward solution. However, what throws many orthopedic practice coders off is that these is no time-based definition—no set number of days, months, or years—before an “acute” injury becomes “chronic.”
To code correctly, look for one of these 3 signs in the documentation:
- Exact terms: The physician specifies the injury as “acute” or “chronic.” Now you know how to code.
- Clear description: If the documentation states that the injury is new, traumatic, and/or recent—you code for acute. If the documentation states that the injury has been an issue for the patient for years—you code for chronic.
- Hidden clues: Not all documentation offers a clear roadmap, so you might have to parse the physician’s description for coding clues. Here are some hints: Acute injuries are typically a sudden and direct result of trauma, while chronic injuries result from overuse or general wear-and-tear (e.g., aging knee joints wear out, arthritis develops, etc.). If the physician describes the injury as sudden, code for acute. If the physician describes general wear-and-tear, code for chronic.
If in doubt: If you can’t figure out what the documentation is telling you, ask the physician who wrote the notes whether the injury is acute or chronic. Although educated guesses are made with good intentions, in the end you’d just run the risk of claim denials or questions from the payer.
Meniscal Tears: Not Always Acute
To gain clarity on the issue, let’s look at an injury that often confuses coders: meniscal tears. A common misconception in both the public and the medical community is that this injury is sudden and traumatic. On the contrary, it’s often just an old tear that finally had enough.
When coding for meniscal tears, you’ll either use the S codes for acute injuries, or the M codes for chronic ones. S codes encompass S83.20-S83.289, and the M codes fall under M23.2 and offer you over a dozen codes. The fact that you have so many options makes it imperative to know whether the injury was acute or chronic. That’s also why the documentation must be clear.
Once you know to code for acute or chronic, ICD-10 makes things relatively easy for you. For old tears, M23.2 involves “derangement of meniscus due to old tear or injury.” The codes are further broken down by the kind of tear, which meniscus was damaged, and which knee was affected.
S codes are broken down in that same way, but you have the option of coding for first encounter (adding “A” to the code), subsequent encounter (adding “D”), or sequela (adding “S”). For example, S83.231 is a complex tear of the medial meniscus on the right knee. To code the different encounters you’d use:
- 231A for the first encounter
- 231D for subsequent encounter
- 231S for sequela
Proactive Coding Preparation
You can expect 109 orthopedic 2019 ICD-10-CM code changes—effective October 1, 2018. Be proactive, learn new codes, and clear up existing confusions – such as coding acute v. chronic injuries. That’s your best bet to battling future denials. The ICD-10 orthopedic codes can be tricky, says Vaught, but with a little attention to detail and a lot of in-depth knowledge, you’ll be ready for any situation headed your way!
