ICD-10-CM/PCS – Part 66: Question & Answer

Author: Linda Kobayashi, BA, RHIT, CCS
Editor: Andrea Wong, BS, RHIT

We began a discussion of orthopedic surgery with the 11/3 tidbit, spinal fusion. This week we are going to continue our discussion on fusion.

Problem for this week:

The patient, a 25-year-old man, was a passenger in a motor vehicle accident involving collision with another car in which he sustained non-displaced hairline fractures of two adjacent carpal bones, the trapezoid and the capitate. His physician diagnosed his right hand with post-traumatic arthritis. To correct this condition, the patient underwent an inter-carpal fusion of the right hand with bone bank bone graft, open. Note: Assign E code for external cause of injury.

 

 

 

 

 

 

 

 

Who-We-Are

 

 

 

 

 

 

Answer Key

  • M19.141 = Post-traumatic osteoarthritis, right hand
  • S62. 134S = Non-displaced fracture of capitate [os magnum] bone, right wrist, sequela
  • S62.184S = Non-displaced fracture of trapezoid [smaller multangular], right wrist, sequela
  • V43.62XS = Car passenger injured in collision with other type car in traffic accident, sequela
  • 0RGQ0KZ = Fusion of right carpal joint with non-autologous tissue substitute, open approach

 

Breakdown of M19.141

  • M19 = Other and unspecified osteoarthritis
  • M19.1 = Post-traumatic arthritis of other joints
  • M19.14 = Post-traumatic arthritis, hand
  • M19.141 = Post-traumatic osteoarthritis, right hand

 To locate M19.141, Post-traumatic arthritis:

  • Disease Index > Osteoarthritis > post-traumatic > hand joint > M19.14- > Go to Tabular Tabular > Assign 6th character, 1 – right, for laterality > M19.141: Post-traumatic osteoarthritis, right hand.

To locate S62.134S:

  • Disease Index > Fracture, traumatic > carpal bones > capitate > non-displaced > S62.13- > Go to Tabular > Assign 6th character, 4 – right, for non-displaced and laterality > Go to box under category S62 to select the appropriate 7th character > S (Sequela) > S62.134S: Non-displaced fracture of capitate [os magnum] bone, right wrist.

To locate V43.62XS: External Causes Index > Accident > car > see Accident, transport, car occupant > collision (with) > passenger > collision (with) > car (traffic) > V43.62 > All ICD-10-CM codes must be 7 characters in length but the Index doesn’t instruct you to add a placeholder. The placeholder is always identified by the character, “X.” After adding the X to V43.62, you still have to assign the 7th character. Locate the box immediately below category V43, “Car occupant injured in collision with car, pick-up or van,” and select the appropriate 7th character, S for sequela.

Comments for diagnostic codes:

  • There are 8 small carpal bones in the wrist that are firmly bound and organized into 2 rows that consists of 4 bones each.
  • Sequela (S) is to ICD-10 what Late Effects is to ICD-9-CM. We once again have new terminology, with “Sequela” replacing “Late Effects.”
  • Official definition of Sequela: “A sequela is the residual effect (condition produced) after the acute phase of an injury or illness has terminated. There is no time limit on when a sequela code can be used.”
  • Sequencing of sequela codes: Coding of sequela generally requires two codes sequenced in the following order: The condition or nature of the sequela is sequenced first followed by the sequela code(s).
  • The 7th character ‘S’): Use for complications or conditions that arise as a direct result of an injury. Use both the injury code, with 7th character ‘S’, that precipitated the sequela and the code for the sequela itself. The 7th character ‘S’ identifies the injury responsible for the sequela. The specific type of sequela (e.g., scar) is sequenced first, followed by the injury code.
  • If there is a dash following a code, it means it is incomplete, as is true with one of our diagnostic codes, S62.18-. You must go to the Tabular and after locating code S62.18- replace the dash with the appropriate 6th character, 4, “Non-displaced fracture of trapezoid [smaller multangular].”

Location of 0RGQ0KZ:

  • PCS Index > Fusion > Carpal > Right > 0RGQ > Locate table 0RG and go across the row to finish building the code after verifying that the 4th character if Q is correct:

Fusion of Right Carpal Joint with Non-autologous Tissue Substitute, Open Approach

PCS Root Ops 66 

Comments:

  1. The dividing line between upper joints versus lower joints:
  2. Upper bones/joints are identified as bones and joints above the level of the lumbar vertebrae, plus upper extremities.
  3. Lower bones/joints are the bones and joints of the lumbar vertebrae and below, plus the lower extremities.
  4. Definition of Fusion: Joining together portions of an articular body part, rendering the articular body part immobile. The body part is joined together by fixation device, bone graft, or other means (including rods, plates, screws).
  5. Coding Clinic Note: No additional code is assigned for fixation devices (rods, plates, pedicle screws) in spinal fusions.
  6. Guideline B3.10c: Combinations of device and materials
  7. Autologous and non-autologous tissue substitutes are reported when ‘only’ bone graft is used, and no inter-body device is used at that same joint level.
  8. If autologous bone is harvested locally from the site, then it is not coded separately.
  9. Main role of carpus: To facilitate effective positioning of the hand and powerful use of the extensors and flexors of the forearm. The mobility of individual carpal bones increase the freedom of movements at the wrist. The carpal bones allow the wrist to move and rotate vertically.
  10. Note: The corresponding part of the foot is the tarsus.

 

Directions for Locating Code by Going Directly to the Tables

Fusion of Right Carpal Joint with Non-autologous Tissue Substitute, Open Approach

0RGQ0KZ

  1. Step 1: Locate the correct section in your PCS coding book. You know that surgery was performed, so the most logical selection is the Med/Surg section. The first character value in this section is always 0.
  2. Step 2: Determine the Body System: In ICD-10-PCS, joints are categorized by upper joints versus lower joints:
    1. Upper bones/joints are identified as bones and joints above the level of the lumbar vertebrae, plus upper extremities.
    2. Lower bones/joints are the bones and joints of the lumbar vertebrae.
  3. Step 3: Determine the root operation. Root operations are listed alphabetically. The first thing you do is locate the Upper Joints section in the PCS tables. You all ready have the 1st 2 characters 0R. Now you need to find the root operation, Fusion, which has a value of G. The 1st 3 characters are easy to find because the format for the PCS tables always lists the Section, Body System and Root Operation immediately above the table. So far we have 3 character values, 0RG.
  4. Step 4: Body Part(s). We know that the body parts are the two hairline fractures, the trapezoid and the capitate, with a value of Q; now have 4 characters, 0RGQ.
  5. Step 5: Determine the approach. This is easy because in our scenario, the coding problem states that the approach is open. Open approach always has a character value of 0. We’re up to 5 character values, 0RGQ0.
  6. Step 6: If there is a device left in place at the end of the procedure, it must be coded. The interbody fusion device is a non-autologous tissue substitute; in our scenario the substitute is bone bank bone graft with a value of K; we now have 6 character values, 0RGQ0K.
  7. Step 7: Assign the value for the qualifier. There are no qualifiers, so the character value is Z. In ICD-10-PCS, Z is a placeholder. We now have our code, 0RGQ0KZ.

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