Don’t Give Orthopedic Coding Changes the Cold Shoulder

You’re facing more than 300 Current Procedural Terminology (CPT®) and more than 450 ICD-10 coding changes for 2019—and many orthopedic coding changes among them. Unfortunately, none of these changes will make your shoulder surgery coding any easier.

Orthopedics CPT

From bundling and modifier usage, to the growing number of CPT® shoulder codes, it’s all too easy to make mistakes in your shoulder surgery coding, notes orthopedic coding expert Margie Scalley Vaught in her 2019 Coding Updates Virtual Boot Camp for Orthopedics, co-presented Lynn Anderanin. Here are a few tips to keep your ICD-10 shoulder surgery coding on track:

Pay Attention to New Muscular Dystrophy & Myalgia Codes

When you’re coding shoulder surgery or another orthopedic procedure or visit, remember to use the 2019 ICD-10 codes, which already took effect on October 1, 2018. The Centers for Medicare & Medicaid Services (CMS) made a handful of changes to the ICD-10 codes that you’re likely to use in orthopedic coding, according to Modernizing Medicine.

Heads up: In Chapter 6 (Diseases of the Nervous System) CMS added new ICD-10 codes under primary disorders of the muscles. Specifically, you have the following new codes under G71.0 — Muscular dystrophy:

  • 00 — Muscular dystrophy, unspecified
  • 01 — Duchenne or Becker muscular dystrophy
    • Autosomal recessive, childhood type, muscular dystrophy resembling Duchenne or Becker muscular dystrophy
    • Benign [Becker] muscular dystrophy
    • Severe [Duchenne] muscular dystrophy
  • 02 — Facioscapulohumeral muscular dystrophy
    • Scapulohumeral muscular dystrophy
  • 09 — Other specified muscular dystrophy
    • Benign scapuloperoneal muscular dystrophy with early contractures [Emery-Dreifuss]
    • Congenital muscular dystrophy NOS
    • Congenital muscular dystrophy with specific morphological abnormalities of the muscle fiber
    • Distal muscular dystrophy
    • Limb-girdle muscular dystrophy
    • Ocular muscular dystrophy
    • Oculopharyngeal muscular dystrophy
    • Scapuloperoneal muscular dystrophy

More: And in Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue) CMS added the following new codes under M79.1 — Myalgia:

  • 10 — Myalgia, unspecified site
  • 11 — …of mastication muscle
  • 12 — …of auxiliary muscles, head and neck
  • 18 — …other site

Also: Use Added Infection Codes

Watch out: Infections occurring due to or after a procedure are dreaded but inevitable, and you will certainly need to code them from time to time following shoulder surgery or other orthopedic procedures. So be sure to use these new ICD-10 codes for an infection after a procedure.

In Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes), CMS added the following new codes under T81.4 — Infection following a procedure:

  • 40 — Infection following a procedure, unspecified
  • 41 — …superficial incisional surgical site
    • Subcutaneous abscess following a procedure
    • Stitch abscess following a procedure
  • 42 — …deep incisional surgical site
    • Intra-muscular abscess following a procedure
  • 43 — …organ and space surgical site
    • Intra-abdominal abscess following a procedure
    • Subphrenic abscess following a procedure
  • 44 — Sepsis following a procedure (Use additional code to identify the sepsis)
  • 49 — Infection following a procedure, other surgical site

Take in the Whole Picture

Remember: The new ICD-10 codes for 2019 apply to all services performed from October 1, 2018 through September 20, 2019, according to Becker’s ASC Review. In addition to the changes listed above, you can find other significant ICD-10 code changes in:

  • Chapter 1 (Certain Infectious and Parasitic Diseases);
  • Chapter 2 (Neoplasms);
  • Chapter 9 (Diseases of the Circulatory System);
  • Chapter 15 (Pregnancy, Childbirth and the Puerperium);
  • Chapter 18 (Symptoms, Signs and Abnormal Clinical and Laboratory Findings); and
  • Chapter 21 (Factors Influencing Health Status and Contact with Health Services).

Bottom line: Tackling tricky shoulder surgery coding is a big enough job, but you also have to keep up on all the orthopedic coding changes for 2019, Vaught says. Make sure you’re staying current on the 2019 Medicare fee schedule, CPT codes, CCI bundling issues, and ICD-10 diagnosis codes.

And always keep in mind that your ICD-10 coding plays a crucial role in painting a complete picture of a patient’s health status, which is essential to meeting your care-quality and performance goals under programs like the Merit-based Incentive Payment System (MIPS).
Orthopedics CPT

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