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Ensure proper coding in wake of hip/knee revisions

Compliance Monitor, June 14, 2006

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The American Medical Association released the new ICD-9 procedure codes for revisions of hip and knee joint prostheses and new ICD-9 diagnosis codes for mechanical complications of joint prostheses effective October 1, 2005. Selecting which code to use depends on whether the procedure was an implantation or a revision.

Coders also must consider the type of implanted material (e.g., metal-on-metal, ceramic-on-ceramic, or metal-on-polyethylene) for hip implantations.

The easiest solution is to look for the implant logs in the record, which should contain a vendor sticker that describes exactly what type of prosthetic material was implanted. However, sometimes coders use unassembled or incomplete records, which leads to confusion.

"Whether it's defibrillators, stents, or joint replacements, the vendors have done a really good job with this, so [the sticker] ought to be in the record," says Bloomquist.

Also note that an error in the DRG grouper can cause improper assignment of higher-weighted DRG 471 (bilateral joint replacement) to a single joint revision instead of new DRG 545 (for revisions), says Bloomquist. This can happen if a coder selects two components (e.g., a patellar button and tibial liner). The current version of the DRG grouper assigns the two components to 471 rather than 545.

In response, Bloomquist says CMS is currently reviewing all claims with DRG 471 to make sure that it pays for true bilateral joint replacements and not revisions until it corrects the mistake in the DRG grouper next year.

Thanks to DeAnne Bloomquist, RHIT, CCS, chief consultant of Mid-Continent Coding, Inc., in Wichita, KS, and Sandy Sillman, RHIT, PAHM, diagnosis-related group (DRG) coordinator for Henry Ford Health System in Detroit for providing today's tip.

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