Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
We will continue to give you problems that include both diagnoses and procedures. This week we are focusing on a problem from the Diseases of the Musculoskeletal System and Connective Tissue, Chapter 13.
Problem for the week: After falling from a ladder while working on his house, the patient was brought to the ER where he was admitted. He sustained contusions of the scalp and face and an open type I intertrochanteric fracture of the right femur. The fracture site was excisionally debrided, and an open reduction with internal fixation was carried out. Don’t assign E codes except for the external cause of the injury.
- S72.141B: Displaced intertrochanteric fracture of the right femur, initial encounter, for open fracture type I or II
- S00.03xA: Contusion of scalp
- S00.83xA: Contusion of other part of head
- W11.xxxA: Fall from ladder
- 0QS604Z: Open reduction with internal fixation (reposition right upper femur)
- 0QB60ZZ: Debridement (root operation “Excision”)
Breakdown of S72.141B
S72 = Fracture of Femur
S72.1 = Pertrochanteric fracture
S72.14 = Intertrochanteric fracture of femur
S72.141B = Displaced intertrochanteric fracture of right femur; initial encounter, for open fracture type I or II
To locate S00.03xA: Alphabetic Index > Contusion > scalp > S00.03 > Tabular to obtain remaining digits (all ICD-10-CM codes are 7 digits long) > 7th digit required > the next 6th character is x, placeholder in ICD-10-CM > S00.03x > S00.03xA (A is initial encounter.)
To Locate S00.83xA: Alpha Index > Contusion > face NEC > S00.83 > Go to the Tabular to assign remaining digits so you come out with a total of 7 digits > S00.83x > (x is the placeholder for ICD-10-CM, just as Z is the placeholder for procedures) > S00.83xA (A is for initial encounter.)
To Locate W11.xxxA: Index to External Causes > Fall, falling > from, off, out of > ladder > W11 > Tabular: 3rd, 4th, and 5th character, placeholder is x > W11.xxx > 7th character is the A-initial encounter > W11.xxxA.
To Locate 0QS604Z > PCS Index > Reposition > Femur > Upper > Right > 0QS6 > locate table 0QS and go across the row to finish building the code, remembering to verify the 4th character:
Reposition Right Upper Femur with Internal Fixation Device, Open Approach
- PCS divides the bones into upper and lower. Anything above the diaphragm is considered an upper bone and anything below the diaphragm would be considered a lower bone.
- There are some new terms in ICD-10-PCS and this is a good example. Reposition replaces Reduction.
- Reposition is defined as “Moving to another location or other suitable location all or a portion of a body part.
- An intertrochanteric fracture involves the proximal femur, which consists of the femoral head, the femoral neck, and the trochanteric region (including the greater and lesser trochanters.
- The bone was fixated with an internal fixation device. A device is used only to specify devices that remain after the procedure is completed
To Locate 0QB60ZZ: PCS Index > Debridement > Excisional > see Excision > Femur > Upper > Right > 0QB6 > locate table 0QB and go across the row to finish building the code, and remember to verify the 4th character:
Excision of Right Upper Femur, Open Approach
- Before setting the bone, some debridement of the femur was required.
- Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.
- Excision is defined as ‘Cutting out or off, without replacement, a portion of a body part.” Please note that the main difference between these 2 root operations is that in Replacement, it always involves a device. In an excision procedure, which is the case in our scenario, the dead or damaged tissue is not replaced.
- Upper bones versus lower bones applies to this part of the problem, e.g., above/below the diaphragm.
- If you do an alpha search for all root operations in the 0QB tables, you will see that debridement is not included.
Directions for Locating the Codes by Going Directly to the Tables
REPOSITION OF FEMUR WITH ORIF
- Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
- Step 2: Determine the correct Body System – lower bones. Since you are dealing with the Musculoskeletal System (MS) and since you know that the femur is part of the MS System, it should be easy to determine the body system. PCS divides the bones into upper and lower. Thus far, we have identified the first two characters, 0Q.
- Step 3: Determine the root operation. You know you have to be in a table that starts with 0Q. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct root operation. Our root operation is Reposition. We now have the first three characters, 0QS, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Lower Bones; the root operation, Reposition.
- Step 4: Identify the Body Part to determine the 4th character value. The Body Part, upper right femur, should relate to the root operation, Reposition, because it was the femur that was repositioned. We now have 4 character values 0QS6.
- Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an open approach. We should now have 5 characters, 0QS60.
- Step 6: Determine whether or not a device was left in the patient postoperatively. This procedure an ORIF (open “reposition” with internal fixation) was carried out. This clearly indicates that a device was left in place. We should now have 6 characters, 0QS604.
- Step 7: There is no qualifier, so we now have our code of 0QS604Z. Z functions as a placeholder in ICD-10-PCS.