Published 8/1/2014
Margaret M. Maley, BSN, MS

ICD-10 Focus on Common Knee and Shoulder Codes

Much has been written about the explosion of diagnosis codes under the International Classification of Diseases, 10th Edition Clinical Modifications (ICD-10). The amplified granularity of the system and the addition of laterality coding will certainly have an impact on orthopaedics. The ICD-10 implementation delay until Oct. 1, 2015, gives orthopaedic practices an opportunity to take a focused look at the most commonly used codes in ICD-9 and map them to the corresponding codes in ICD-10.

With ICD-10, orthopaedic surgeons will be required to document the location and severity of most injuries and fractures with increased specificity. However, an overview of some common shoulder and knee diagnosis codes reveal that not all codes have expanded exponentially. Table 1 shows knee diagnoses with one-to-one mapping from ICD-9-CM (ICD-9) to ICD 10, with the addition of laterality.

As shown, ICD-10—like ICD-9—has separate categories to indicate chondromalacia of the patella and chondromalacia of the knee.

Not all diagnosis codes were made more specific in ICD-10. The very precise ICD-9 codes describing old or chronic ligament disruptions have been eliminated. In ICD-10, these conditions are reported using a more general code describing chronic instability in the right or left knee, as shown in Table 2.

Shoulder codes
Some common shoulder diagnoses have one-to-one mapping from ICD-9 to ICD-10, except for the addition of laterality (
Table 3).

In some circumstances, ICD-9 diagnoses that were reported using “other specified” or “not elsewhere classified” codes now have specified codes in ICD-10. Impingement syndrome of the shoulder and osteophyte of the shoulder are great examples.

In ICD-9, both impingement syndrome of the shoulder and osteophyte of the shoulder are reported using the same code—726.2, other affections of the shoulder region, not elsewhere classified. Under ICD-10 these conditions will have separate and specific codes (Table 4).

Looking at the orthopaedic ICD-10 codes, laterality is conventionally described with “1” indicating the right side and “2” indicating the left side of the body. But, those characters are not always in the same position.

In the ICD-10 codes for chondromalacia of the patella, chronic instability of the knee, and impingement syndrome of the shoulder, laterality is indicated by the 5th character. The laterality indicator is in the 6th position in the ICD-10 codes for chondromalacia of the knee (not in the patella), ruptures of the rotator cuff (partial or complete), calcific tendinitis of the shoulder, and osteophyte in the shoulder.

Start now to map the most common diagnoses codes from ICD-9 to ICD-10 and take full advantage of the areas where the increased specificity of the system enhances the support of medical necessity for the services provided.

Margaret M. Maley, BSN, MS, is a senior consultant with KarenZupko & Associates, Inc. The information in this article has been reviewed by the AAOS Coding, Coverage, and Reimbursement Committee.