The Centers for Disease Control and Prevention and CMS unveiled their new 2006 ICD-9 codes, and because payers do not allow a grace period for the new codes, you need to get acquainted with the newbies and update your superbills by Sept. 30. Assign Complication Codes Based on Problem Orthopedic practices will benefit from nine new prosthesis or implant complication diagnosis codes:
996.40 - Unspecified mechanical complication of internal orthopedic device, implant, and graft
996.41 - Mechanical loosening of prosthetic joint
996.42 - Dislocation of prosthetic joint
996.43 - Prosthetic joint implant failure
996.44 - Peri-prosthetic fracture around prosthetic joint
996.45 - Peri-prosthetic osteolysis
996.46 - Articular bearing surface wear of prosthetic joint
996.47 - Other mechanical complication of prosthetic joint implant
996.49 - Other mechanical complication of other internal orthopedic device, implant, and graft. Deletion alert: ICD-9 will delete the unspecific code 996.4 (Mechanical complication of internal orthopedic device, implant, and graft) to make room for the more detailed codes. "Code 996.4 has been expanded to five digits, so we will now be able to report the specific mechanical complication of the orthopedic implant or device," says Leslie Follebout, CPC, coding department supervisor at Peninsula Orthopaedic Associates PA in Salisbury, Md.
Coders hope that the new codes will help paint a clearer picture for payers, so they can decrease their chances of having to resubmit claims, face requests for more information, or appeal denials.
Previous Codes Lacked Specificity "I'm glad that some specific codes will be available for problems with previously placed orthopedic hardware," says Denise Paige, CPC, coding/billing manager at Beach Orthopedic Associates in Long Beach, Calif., and president of the AAPC's Long Beach Chapter.
"Right now there are only a few codes to indicate a problem (996.4, 996.67, 996.77 and 996.78)," Paige says, "which are used a lot, but aren't very specific." 2 Examples Show You the Way Example 1: You might use 996.43 if the actual prosthesis device broke, Follebout says, or if a locking ring on a total hip replacement broke.
Example 2: Code 996.45 would apply if the patient had osteolysis due to a prosthetic complication. "As the prosthesis begins to wear out, little pieces of the plastic liner will come off and be absorbed into the hip joint," Follebout says.
"Osteolysis is the body's reaction to the presence of the microscopic pieces of plastic," Follebout says. "As the body absorbs the plastic, it also begins to absorb the bone, [...]