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In this Issue
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Hip Impingement or Femoroacetabular Impingement (FAI)
Coding Corner Q&A
ICD-10 Spotlight
Hip Impingement or Femoroacetabular Impingement (FAI)
It is common for coders to see the diagnosis “Shoulder Impingement” when coding a
medical record; however, only in the recent past are we seeing documentation from
doctors about FAI or Hip Impingement. It can occur in people of all ages, including
adolescents and young adults. Untreated hip impingement can lead to hip
osteoarthritis. People with FAI may have a congenitally structured abnormal ball-andsocket joint. In other cases, the hip joint becomes structurally abnormal during
development. Repetitive activity seen in various sports may cause hip impingement.
Additionally, certain conditions, such as Perthes disease and Slipped Capital Femoral
Epiphysis may lead to FAI.
Definition: Impingement refers to pinching or compression of the soft tissue around
the hip socket. “Femoroacetabular” further defines where the impingement is
occurring: where the round head of the femur meets the acetabulum or hip socket.
Types of Hip Impingement:
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Cam Impingement
Pincer Impingement
Cam Impingement is the most common type and occurs when the femoral head is not
round enough to move properly inside the hip socket. This results in a shearing force
on the labrum and the articular cartilage.
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Labrum: a “lip” or a ring of fibrocartilage covering the acetabulum.
Articular cartilage: the covering over the the hip joint surface.
This abnormal contact between the femur and the acetabulum is the leading cause of
labral tears and degenerative hip arthritis.
Pincer Impingement happens when the rim of the articular cartilage covers too much of
the femoral head. When the femur flexes or rotates, this cartilage gets pinched. The
femoral head should move smoothly inside the hip socket. The socket is just the right
size to hold the head in place. But in FAI, the hip socket may be too deep. Gradually,
this pinching, or impingement, of the labrum can cause fraying and tearing of the
edges and/or osteoarthritic changes may develop.
Surgical Treatment:
In some cases surgical intervention is needed. Surgery may be minimally invasive
(arthroscopic) or an open approach may be indicated to ensure full correction of the
deformity. If there is a labral tear, the torn labrum will be reattached. Each layer of
tissue is sutured back together and reattached along the rim of the acetabulum. If
repair is not possible, then debridement (shaving or removing) of the torn labral tissue
may be needed. If extensive damage to the cartilage is found, then the patient may
need a total hip replacement.
There are different types of surgical “repairs” that can be performed to correct an FAI.
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Labral Tissue Refixation or Reattachment
Labral Tissue Debridement
Femoral Shaving or Femoroplasty
Acetabuloplasty
Total Hip Arthroplasty or Hip Replacement
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Arthroscopic Approach & Open Approach
Coding Exercise
We will look at coding a Repair of FAI, left hip, with a labral tear reattachment via
arthroscopic approach.
ICD-9-CM:
843.8
Sprain of hip and thigh
719.85
Disorder of Joint, Pelvic Region/Thigh
ICD-10-CM:
S73.192A
Other Sprain of Left Hip, Initial Encounter
M25.852
Other Specified Joint Disorder, Left Hip
ICD-9-CM:
81.40
Repair of Hip, NEC
CPT:
29916-LT
Arthroscopy, hip, surgical; with labral repair
ICD-10-PCS:
OSQB4ZZ
Repair Left Hip Joint, Percutaneous Endoscopic Approach
References:
ICD-10-PCS Official Draft Code Set
ICD-10-CM Official Draft Code Set
Coding Clinic, 4th Quarter ICD-10 2014, pp. 25-26
CPT Assistant, September 2011, pp. 5-7
Coding Corner Q & A
Question :
MD lists in the Plan/Assessment the
following diagnosis:
Atrial fibrillation
Hypertension
Is that coded as:
427.31 (I48.91)
402.90 (I11.9)
or
427.31 (148.91)
401.9 (I10)
Do you have a coding
question? Send it to us and
it may be featured in our
next issue.
Answer:
The correct code assignment for Atrial fibrillation and Hypertension is:
ICD-9-CM:
427.31 and 401.9
ICD-10-CM: I48.91 and I10
Coding Clinic, states that a casual or implied relationship of the patient’s
hypertension and cardiac disease must be documented by the physician. This
means the physician must make a statement such as, due to hypertension or
hypertensive. Also, codes from the 402 category are usually only assigned with
heart conditions classified to 425.8, 429.0-429.3, 429.8, and 429.9.
References:
Coding Clinic, 4th Qtr, 2008 pg. 236-241
Coding Clinic, July-August 1984, pg. 12-17
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ICD-10 Spotlight
Female Reproductive System
This month, the ICD-10 Spotlight will be covering Release and Destruction.
Destruction is the physical eradication of all or a portion of a body part by the direct
use of energy, force, or a destructive agent. In the example below, a hemostat and
even the surgeon’s finger are used to pry the fibroids away from the uterus.
Procedures typical for Destruction are cautery of a nosebleed, talc injection
pleurodesis, and fulguration of endometrium. In ICD-10 it is important to convert
common terminology to the appropriate root operation. As you can see in these
examples, the “procedures” are composed of a variety of words but the root operation
is Destruction for all of them.
Release is freeing a body part from an abnormal physical constraint by cutting or by
use of force. Release procedures are coded to the body part being freed. Do not code
the tissue being manipulated or cut to free the body part.
Procedures typical of those coded to Release are carpel tunnel release, incision of
scar contracture or, as in the case listed below, adhesiolysis to name just a few .
Female Reproductive System
Pre-op diagnoses:
1. Uterine fibroids
2. Menorrhagia
3. Morbid Obesity
Postop Diagnoses:
Same, with addition of extensive pelvic adhesions
Procedures:
Abdominal myomectomy
Extensive pelvic adhesiolysis
After general anesthetic was found to be adequate, a midline incision was made and
extended down to the underlying layer of the fascia. The fascia was excised and
extended. The rectus muscle was then separated in the midline. The peritoneum was
identified, tented up and entered. This incision was then extended superiorly and
inferiorly with excellent visualization of the bladder.
Multiple pelvic adhesions involving extensive lysis were noted with the omentum
adherent to the large intestine and the anterior surface/fundus of the uterus that were
taken down using blunt dissection as well as scissors. Once adequate visualization of
the uterus was obtained, it was palpated in order to determine where the first incision
should be made. A linear incision was made and a hemostat was used in order to peel
away the fibroid from the capsule, also using a finger to dissect around the fibroid. The
fundal fibroid and two smaller fibroids were removed from this incision and then
handed off to the nurse.
In a similar manner, on the anterio-inferior midline surface of the uterus, a linear
incision was also made and multiple fibroids removed. The uterine cavity was then
entered and all palpable fibroids removed. The defects in the uterus were closed and
excellent hemostasis was noted. All layers were then closed and then bandaged
appropriately.
ICD-9 CM Diagnoses:
218.9
626.2
278.01
614.6
ICD-9 Procedures:
68.29
54.59
ICD-10-CM:
D259
E6601
N920
N736
ICD-10-PCS:
0U590ZZ
0UN90ZZ
0DNE0ZZ
Reference:
ICD-10 Guidelines B3.13
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