© 2019 Aquity Solutions 1

CodingCondently

August, 2019

Navigating ICD-10-PCS Code Assignment for Joint Replacements

Are you struggling with proper ICD-10-PCS code assignment

for joint replacements? Let me put your mind at ease!

We'll start with the root operation Replacement. The definition is: “putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.” And the explanation is: “the body part may have been taken out or replaced, or may be taken out, physically eradicated, or rendered nonfunctional during the Replacement procedure. A Removal procedure is coded for taking out the device used in a previous replacement procedure.”

Examples: Total hip arthroplasty, Total knee replacement, Unicondylar (Partial) knee replacement

CodingCondently Navigating ICD-10-PCS Code

Assignment for Joint Replacements

Total right knee replacement (including patella):

https://en.wikipedia.org/wiki/Knee_replacement

https://commons.wikimedia.org/wiki/File:Hip_Replacement.png

Most coders struggle with the correct assignment of the device and qualifier values, so let's dig a little deeper into these values.

The device value is also known as the joint bearing surface. This surface is where the synthetic components of the replaced joint meet. For example, in the hip, the bearing surface is where the replaced femoral head meets the replaced acetabular cup. If both the femoral head and the acetabular cup are metal, then the bearing surface (device value) is synthetic substitute, metal (1). If the femoral head is ceramic and the acetabular cup is polyethylene, then the bearing surface (device value) is synthetic substitute, ceramic on polyethylene (4).

If the specific type of bearing surface is not available in the medical record, assign synthetic substitute (J) for the device value, or query the provider for clarification. If the operative report does not specify, look for the manufacturer product information sticker elsewhere in the record or review the manufacturer's website for type of material the bearing surface is made from.

The qualifier is the other value that gives coders trouble. The options for this value are: Cemented (9), Uncemented (A), or No Qualifier (Z). Cemented means the joint is attached to bone with epoxy cement. An uncemented or cementless replaced joint has a mesh of holes on its surface that allows the growth of the patient's natural bone to hold the joint in place, for example, a press-fit implant is cementless. The final qualifier is no qualifier. This is assigned when the documentation is insufficient to determine whether the joint substitute is cemented or uncemented.

As stated in Section A11 of the ICD-10-PCS guidelines, “Many terms used to construct PCS codes are defined within the system. It is the coder's responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined PCS terms is clear.”

© 2019 Aquity Solutions 2

© 2019 Aquity Solutions 3

CodingCondently Navigating ICD-10-PCS Code

Assignment for Joint Replacements

What about revisions? This term is commonly misunderstood. A Revision, by definition, is “correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device.” If the procedure performed is a complete re-do of a procedure, then it is coded to the root operation performed. For example, a previously replaced joint is being replaced again due to age. This is coded to root operation Removal and Replacement not Revision even though surgeons commonly use this terminology in the operative report. A true joint revision would entail an adjustment or reposition of the malfunctioning device or re-cementing a loose component.

Occasionally, a new liner is placed. When this occurs, we use root operation Supplement. A liner (i.e. acetabular or tibial) is placed to physically reinforce the replaced joint. It is not functioning as a replaced body part. When a previously place joint liner is replaced, assign both Supplement and Removal of the new liner.

Case example: Patient presents for a revision of left knee arthroplasty. The left medial compartment and tibial insert were replaced.

ICD-10-PCS codes:

0SPD0LZ, Removal of medial unicondylar synthetic substitute from left knee joint, open approach 0SRD0LZ, Replacement of left knee joint with medial unicondylar synthetic substitute, open approach 0SPD09Z, Removal of liner from left knee joint, open approach 0SUW09Z, Supplement left knee joint, tibial surface with liner, open approach

Thank you for taking a few minutes to review this month's newsletter. We look forward to providing more coding education in the future. For future topic suggestions, please email suggestions to Education@AQuitySolutions.com.

Editor: Shelley Brock, MSA, RHIT, CCS, CCS-P, CDIP, CPC, CPMA

References: ICD-10-PCS Official Guidelines for Coding and Reporting 2019ICD-10-PCS Reference ManualCoding Clinic, 3rd Quarter 2015 pages 18-19Coding Clinic, 3rd Quarter 2016 pages 35-36Coding Clinic, 2nd Quarter 2015 pages 18-19