ICD-10-CM
Coding Workbook
for Orthopaedics
Specialty coding guidance for ICD-10-CM
2017
Contents
Introduction .............................................................................................................................................. 1
Overview of ICD-10 .............................................................................................................................................................................................. 1
Getting Ready for ICD-10 ................................................................................................................................................................................... 2
Using This ICD-10-CM Workbook ..................................................................................................................................................................... 2
Workbook Guidelines .......................................................................................................................................................................................... 3
Online Exams to Test Your ICD-10-CM Coding Skills ................................................................................................................................... 4
Summary ................................................................................................................................................................................................................ 4
Case Studies and Questions ...................................................................................................................... 5
Case Study #1—Total Knee Arthroplasty ....................................................................................................................................................... 5
Case Study #2—Radial Shaft Fracture ............................................................................................................................................................ 8
Case Study #3—Total Hip Arthroplasty ........................................................................................................................................................12
Case Study #4—Periprosthetic Fracture of Femur ....................................................................................................................................14
Case Study #5—Trigger Finger Release .......................................................................................................................................................17
Case Study #6—Digital Neuroma ..................................................................................................................................................................19
Case Study #7—Degenerative Joint Disease, Shoulder ...........................................................................................................................21
Case Study #8—ACL Tear ................................................................................................................................................................................23
Case Study #9—Radioulnar Synostosis ........................................................................................................................................................26
Case Study #10—Lunate Stress Fracture .....................................................................................................................................................28
Case Study #11—Fracture of Thumb ............................................................................................................................................................30
Case Study #12—Gangrene of Foot ..............................................................................................................................................................32
Case Study #13—Idiopathic Osteoporosis ..................................................................................................................................................35
Case Study #14—Rupture of Quadriceps Tendon .....................................................................................................................................37
Case Study #15—Wrist Laceration with Tendon Injury ...........................................................................................................................40
Case Study #16—Cervical Stenosis with Myelopathy ..............................................................................................................................43
Case Study #17—Rotator Cuff and Labral Tear of Shoulder ...................................................................................................................46
Case Study #18—ACL and Meniscus Injury, Knee .....................................................................................................................................49
Case Study #19—Meniscal Tear and Osteochondral Fracture, Knee ....................................................................................................51
Case Study #20—Degenerative Joint Disease, Shoulder .........................................................................................................................55
Case Study #21—Status Postlumbar Decompression with Osteoporosis ...........................................................................................57
Case Study #22—Osteoarthritis and Myofascial Pain Syndrome ..........................................................................................................62
Case Study #23—Left Foot Pain .....................................................................................................................................................................64
Case Study #24—Left Knee Pain ....................................................................................................................................................................67
Case Study #25—Humeral Fracture ..............................................................................................................................................................70
Case Study #26—Distal Fibular Fracture .....................................................................................................................................................73
Case Study #27—Planovalgus Feet with Myotonic Muscular Dystrophy ............................................................................................77
Case Study #28—Chronic Plantar Fasciitis ..................................................................................................................................................80
Case Study #29—Posterior Calf Pain ............................................................................................................................................................82
Case Study #30—Bunion and Hammer Toe ................................................................................................................................................85
Case Study #31—Erythema of the Knee ......................................................................................................................................................89
Case Study #32—Chronic Pain .......................................................................................................................................................................91
Case Study #33—Back and Shoulder Pain ...................................................................................................................................................94
Case Study #34—Carpal Tunnel Syndrome ................................................................................................................................................98
Case Study #35—Lytic Lesion of Cervical Vertebrae .............................................................................................................................. 100
Case Study #36—Patellar Tendon Rupture .............................................................................................................................................. 102
Case Study #37—Above-the-Knee Amputation ..................................................................................................................................... 105
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Contents
ICD-10-CM Coding Workbook for Orthopaedics
Case Study #38—Avascular Necrosis of Hip ............................................................................................................................................107
Case Study #39—Neck Pain Following MVA ............................................................................................................................................109
Case Study #40—Shoulder Osteoarthritis .................................................................................................................................................111
Case Study #41—Trauma to Finger ...........................................................................................................................................................114
Case Study #42—Open Tibia Fibula Fracture ...........................................................................................................................................117
Case Study #43—Transmetatarsal Amputation ......................................................................................................................................119
Case Study #44—Displaced Fifth Metacarpal Fracture ..........................................................................................................................121
Case Study #45—Follow-up for Tibial Plateau Fracture ........................................................................................................................123
Case Study #46—Removal of Painful Instrumentation and Placement of L5-S1 Rods ..................................................................125
Answers and Rationales ........................................................................................................................ 127
Case Study #1—Total Knee Arthroplasty ..................................................................................................................................................127
Case Study #2—Radial Shaft Fracture ........................................................................................................................................................129
Case Study #3—Total Hip Arthroplasty .....................................................................................................................................................131
Case Study #4—Periprosthetic Fracture of Femur ..................................................................................................................................133
Case Study #5—Trigger Finger Release .....................................................................................................................................................135
Case Study #6—Digital Neuroma ................................................................................................................................................................137
Case Study #7—Degenerative Joint Disease, Shoulder .........................................................................................................................138
Case Study #8—ACL Tear ..............................................................................................................................................................................140
Case Study #9—Radioulnar Synostosis ......................................................................................................................................................143
Case Study #10—Lunate Stress Fracture ...................................................................................................................................................145
Case Study #11—Fracture of Thumb ..........................................................................................................................................................147
Case Study #12—Gangrene of Foot ............................................................................................................................................................149
Case Study #13—Idiopathic Osteoporosis ................................................................................................................................................152
Case Study #14—Rupture of Quadriceps Tendon ...................................................................................................................................154
Case Study #15—Wrist Laceration with Tendon Injury .........................................................................................................................156
Case Study #16—Cervical Stenosis with Myelopathy ............................................................................................................................158
Case Study #17—Rotator Cuff and Labral Tear of Shoulder .................................................................................................................160
Case Study #18—ACL and Meniscus Injury, Knee ...................................................................................................................................162
Case Study #19—Meniscal Tear and Osteochondral Fracture, Knee ..................................................................................................164
Case Study #20—Degenerative Joint Disease, Shoulder ......................................................................................................................167
Case Study #21—Status Postlumbar Decompression with Osteoporosis .........................................................................................169
Case Study #22—Osteoarthritis and Myofascial Pain Syndrome ........................................................................................................172
Case Study #23—Left Foot Pain ..................................................................................................................................................................174
Case Study #24—Left Knee Pain ..................................................................................................................................................................176
Case Study #25—Humeral Fracture ............................................................................................................................................................178
Case Study #26—Distal Fibular Fracture ...................................................................................................................................................180
Case Study #27—Planovalgus Feet with Myotonic Muscular Dystrophy .........................................................................................182
Case Study #28—Chronic Plantar Fasciitis ................................................................................................................................................184
Case Study #29—Posterior Calf Pain ..........................................................................................................................................................186
Case Study #30—Bunion and Hammer Toe .............................................................................................................................................188
Case Study #31—Erythema of the Knee ....................................................................................................................................................190
Case Study #32—Chronic Pain .....................................................................................................................................................................192
Case Study #33—Back and Shoulder Pain ................................................................................................................................................194
Case Study #34—Carpal Tunnel Syndrome ..............................................................................................................................................197
Case Study #35—Lytic Lesion of Cervical Vertebrae ..............................................................................................................................199
Case Study #36—Patellar Tendon Rupture ...............................................................................................................................................201
Case Study #37—Above-the-Knee Amputation ......................................................................................................................................204
Case Study #38—Avascular Necrosis of Hip ............................................................................................................................................207
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ICD-10-CM Coding Workbook for Orthopaedics
Contents
Case Study #39—Neck Pain Following MVA ............................................................................................................................................ 209
Case Study #40—Shoulder Osteoarthritis ................................................................................................................................................ 211
Case Study #41—Trauma to Finger .......................................................................................................................................................... 214
Case Study #42—Open Tibia Fibula Fracture .......................................................................................................................................... 216
Case Study #43—Transmetatarsal Amputation ...................................................................................................................................... 219
Case Study #44—Displaced Fifth Metacarpal Fracture ......................................................................................................................... 221
Case Study #45—Follow-up for Tibial Plateau Fracture ....................................................................................................................... 223
Case Study #46—Removal of Painful Instrumentation and Placement of L5-S1 Rods ................................................................. 225
Appendix A. Quick Coding Reference ................................................................................................... 227
How to Use ........................................................................................................................................................................................................ 227
Spinal Conditions ............................................................................................................................................................................................ 229
ICD-10-CM Mapping ................................................................................................................................................................................ 231
Fractures ............................................................................................................................................................................................................ 235
ICD-10-CM Mapping ................................................................................................................................................................................ 237
Joint Conditions and Injuries ........................................................................................................................................................................ 265
ICD-10-CM Mapping ................................................................................................................................................................................ 268
Other Traumatic Injuries ................................................................................................................................................................................ 276
ICD-10-CM Mapping ................................................................................................................................................................................ 279
General Musculoskeletal ............................................................................................................................................................................... 290
ICD-10-CM Mapping ................................................................................................................................................................................ 292
Appendix B. ICD-10-CM Official Guidelines for Coding and Reporting 2016 ...................................... 295
Section I. Conventions, general coding guidelines and chapter specific guidelines .................................................................... 300
Section II. Selection of Principal Diagnosis .............................................................................................................................................. 351
Section III. Reporting Additional Diagnoses ............................................................................................................................................. 353
Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services ........................................................................ 354
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Case Studies and Questions
ICD-10-CM Coding Workbook for Orthopaedics
Case Study #23—Left Foot Pain
Description
Consultation for left foot pain
Chief Complaint
Left foot pain
History
The patient is a basketball player for Optum University who was injured in a game one day prior. He
jumped and came down twisting his foot and injuring it. He had an immediate onset of swelling and
pain. The trainer taped up his foot and he was able to continue playing in the game. Following the game
he was further examined by the trainer and had some tenderness around the navicular. The patient has
been taped up firmly and in a walking boot since the game. He does have pain with any type of
weightbearing activities and is limping a bit. He has not suffered any significant foot injuries in the past.
The majority of the pain is located around the dorsal aspect of the hind and midfoot.
Physical Examination
Patient has swelling from the hindfoot out toward the midfoot. The arch is maintained however. Motion
at the ankle and subtalar joints is preserved, and forefoot motion is intact. He complains of pain with
adduction and abduction across the hindfoot, most of the discomfort presenting laterally. Motor
strength is grossly intact, as is sensation. Pulses are strong and palpable. The ankle is not tender. There is
no medial tenderness over the ATFL, along the deltoid, or the medial malleolus. His anterior drawer is
solid. External rotation stress is not painful at the ankle. Tarsometatarsal joints 1, 2, and 3 are nontender.
The majority of tenderness is found laterally along the calcaneocuboid joint and along the anterior
process of the calcaneus. The patient notes some tenderness over the dorsolateral side of the
talonavicular joint as well, although the medial talonavicular joint is nontender.
Radiology
Weightbearing radiographs of the foot show changes that appear chronic over the dorsal aspect of the
navicular. There does not appear to be a definite fracture. Tarsometatarsal joints are anatomically
aligned. Films of the ankle show no fractures but changes along the dorsal talonavicular joint. An MR
scan was also reviewed, which shows some changes along the lateral side of the calcaneocuboid joint
with disruption of the capsular area and lateral ligament. It also shows some changes to the dorsal
talonavicular joint, but no significant marrow edema or definitive fracture line.
Impression
Left Chopart joint sprain
Plan
Continue with walking boot for weightbearing activities. Start a functional rehab program and progress
back to activities as symptoms allow. Patient is aware that a prolonged duration of recovery is
sometimes needed for this type of a hindfoot injury, and additional injury can occur if appropriate plan is
not followed.
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Answers and Rationales
ICD-10-CM Coding Workbook for Orthopaedics
Case Study #23—Left Foot Pain
Answers
1.
Assign the correct ICD-10-CM diagnosis codes for the above encounter.
S93.692A Other sprain of left foot, initial encounter
Y93.67
Activity, basketball
Y92.310
Basketball court as the place of occurrence of the external cause
This type of foot sprain can be difficult to code due to the number of different ligaments found in
the foot structure. The patient suffered a Chopart joint sprain, which is a sprain of the midtarsal
region of the foot. It typically involves the dorsal calcaneocuboid ligament or the bifurcate
ligament. In order to find the appropriate code, main term “Sprain” and subterm “foot” should be
identified in the alphabetic index. The only ligaments listed under foot are the tarsal ligament and
the tarsometatarsal ligament. The most accurate choice based on the knowledge gained about
Chopart joint sprains is “specified ligament NEC,” which references S93.69-. The tabular list
indicates that seven characters are required for a complete code selection. Sixth character “2”
represents the left foot and seventh character “A” indicates that this encounter is within the initial
encounter phase of this injury.
External cause codes provide additional information about the mechanism of injury. This was a
twisting injury of the foot. In the Index to External Causes, main term “Twisting” and subterm
“excessive” seem to be the only appropriate option. This listing tells the coder to see category Y93.
This category includes the activity codes, which describe the type of activity the patient was taking
part in when the twisting injury occurred. Main term “Activity” and subterm “basketball” reference
code Y93.67, which when verified in the tabular list is deemed appropriate and complete. It is also
possible to indicate where the injury occurred. Main term “Place of occurrence” and subterm
“basketball court” reference code Y92.310. The tabular list verifies that this is the appropriate code
choice.
2.
Match the following bones of the foot and ankle with the correct definition.
Bones
Definitions
a. Navicular__3__
1. Sits on top of the calcaneus, also known as the ankle
bone
b. Calcaneus __2__
2. Largest tarsal bone of the foot, also called the heel
bone
c. Cuboid __5__
3. Small tarsal bone that sits at the top of the midfoot
d. Talus __1__
4. Rounded protuberances on each side of the ankle
e. Malleolus __4__
5. Small tarsal bone that sits toward the outside of the
foot, in the midfoot area
These bones are all part of the foot and ankle. It is vital to know and understand the bone structure
of various parts of the body in order to report ICD-10-CM codes accurately.
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ICD-10-CM Coding Workbook for Orthopaedics
3.
Answers and Rationales
If this patient had endured a nondisplaced navicular fracture in his foot, which ICD-10-CM
diagnosis code would be reported?
a. S62.002A Unspecified fracture of navicular [scaphoid] bone of left wrist, initial encounter for
closed fracture
b. S62.035A Nondisplaced fracture of proximal third of navicular [scaphoid] bone of left wrist,
initial encounter for closed fracture
c. S92.255A Nondisplaced fracture of navicular [scaphoid] of left foot, initial encounter
for closed fracture
d. S62.015A Nondisplaced fracture of distal pole of navicular [scaphoid] bone of left wrist, initial
encounter for closed fracture
There is a navicular bone in the foot and the wrist, so it is important to be aware of which area is
being treated and, therefore, being coded. In this instance, it is the navicular bone in the foot. A
nondisplaced navicular fracture of the foot would be appropriately assigned to S92.255 with
seventh character “A” representing the initial encounter.
4.
What would be the appropriate additional external cause code if this injury came from
being stepped on by one of the players on the other team?
W50.0XXA Accidental hit or strike by another person, initial encounter
If this injury was the result of the patient being stepped on by a player on the opposite team, there
is an additional code that can be added to the current external cause codes already provided.
Main term “Stepped on by” and subterm “person” in the Index to External Causes reference code
W50.0. The tabular list indicates that seven characters are required for this code. Characters five
and six are “X” placeholders. Character seven is an “A” to indicate the initial encounter for this
injury. According to the ICD-10-CM Draft Official Guidelines for Coding and Reporting, Section
I.C.20.a.4, it is appropriate to report as many external cause codes as necessary to completely
explain the circumstances.
5.
This patient returned for a follow-up visit three months later. He was having no further
problems and seemed to be healthy, but given his role in athletics it was felt that he
should have this routine follow-up visit. What is the appropriate first-listed ICD-10-CM
diagnosis code for this visit?
a. Z02.5 Encounter for examination for participation in sport
b. Z47.89 Encounter for other orthopedic aftercare
c. S93.692D Other sprain of left foot, subsequent encounter
d. S93.692A Other sprain of left foot, initial encounter
Based on the information provided in the ICD-10-CM Draft Official Guidelines for Coding and
Reporting, Section I.C.19.a, seventh character “D” is used to indicate subsequent encounters. A
subsequent encounter is any encounter that occurs after the active phase of treatment has
concluded for which the patient is receiving routine follow-up care. In this instance, the patient
was returning three months after his initial treatment. Based on the information provided in the
question above, there was no active care still ongoing. This visit was simply for a routine aftercare
visit to verify that the patient was still healing properly and could perform in athletics as needed.
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