American Joint Replacement Registry 10th revision of the ...€¦ · 3 Overview: Currently...
Transcript of American Joint Replacement Registry 10th revision of the ...€¦ · 3 Overview: Currently...
1
American Joint Replacement Registry
10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD10-PCS)
Registry Submission Triggering Code List
August 24, 2015
RRM – 8/24/2015 Added corrected codes and expanded the triggering code set due to errors in the reference document received.
R. Meinzer, AJRR Director of IT
2
Contents Overview: ............................................................................................................................................................................ 3
Background: ...................................................................................................................................................................... 3
Anatomy of an ICD-10-PCS codes, and Operations and Root Operations for joint replacements . 3
ICD10-PCS Procedures .................................................................................................................................................. 6
Primary Total Hip and Knee Procedures ............................................................................................................ 7
Coding Primary Joint Replacement Procedures ......................................................................................... 7
Resurfacing maps to Supplement Operation Code .................................................................................. 7
Hip HemiArthoplasty and Partial HIP (ICD9-PCS 81.52).......................................................................... 8
Using the Revision Operation Code .................................................................................................................... 8
Reporting Codes Previously Referred to as Revisions in ICD9-PCS ........................................................ 9
Appendix 1 ICD9-PCS to ICD10-PCS and CPT mapping table .................................................................... 10
Appendix II Replacement and removal triggering Codes............................................................................. 20
3
Overview: Currently submission of orthopedic hip and knee replacement procedures to the American Joint Replacement Registry (AJRR) is triggered by a list of ICD-9-PCS codes. These codes include both the primary and revision procedures collected by the registry and are subsequently used to produce quality metrics to the AJRR stakeholder community. In October of 2015, a transition to ICD-10 diagnosis and ICD-10-PCS procedure codes will occur requiring hospital to submit the new codes to both the Centers for Medicare & Medicaid Services (CMS) and payers depending on the patient’s coverage. The AJRR, in partnership with orthopedic societies and other orthopedic registries has identified the triggering codes for both primary (index) and revision procedures related to hip and knee joint replacement. This document provides background on the coding system, instructions on how to extract the codes, and the list of triggering codes that the AJRR will collect after the October 1st ICD-10 transition date. The following information is provided as guidance on what ICD-10-PCS replacements, supplements, revisions and removal / replacement procedures (revisions) the AJRR will be collecting. It is not intended as instructions for coding these procedures as institutional coding departments are authority in this area. The analysis AJRR conducted was based on the General Equivalence Mapping System (GEMS) provided by CMS.
Background: The International Classification of Diseases, 10th Revision (ICD-10) was developed in the 1980s by the World Health Organization and has been in use since the early 1990s. Over 25 countries currently use ICD-10. The diagnosis classification is a descendant of ICD-9 and previous versions of the International Classification of Diseases, and has been used by the international community in the reporting of diseases, causes of death, and other epidemiological statistics. The United States developed a more detailed clinical modification of ICD-10 to be used for diagnosis reporting for all medical encounters (ICD-10-CM). As a component of the transition the current ICD-9-PCS procedural reporting system will also transition to ICD-10-PCS .
Anatomy of an ICD-10-PCS codes, and Operations and Root Operations for joint replacements
Source: ICD-10-PCS Procedure Coding System (ICD-10-PCS) 2015 Tables and Index Available from: http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html
ICD-10-PCS codes contain 7 alphanumeric fields as described below. Following below is a description of the anatomy of the code for right total hip replacement with ceramic-on-poly bearing surface: 0SR904A
4
Each alpha-numeric character position in the ICD-10-PCS code has a definition and corresponding set of legal characters as described in the ICD-10 coding requirements. ---------------------------------------------------------------------------------------------------------------- Section Body System Operation Body Part Approach Device Qualifier Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 0 S R 9 0 4 A MedSurg Lower Joints Replacement Hip Joint, Open Synthetic Uncemented Right Substitute Ceramic, on poly
--------------------------------------------------------------------------------------------- The following items include a detail and breakdown of the coding structure in general: Character 1: Section: [0]: Medical and Surgical All entries to AJRR qualify as “0” For example, “Section is defined as the general type of procedure (e.g., medical and surgical, obstetrics, imaging, administration, nuclear medicine, etc.). The first character of the procedure code always specifies the section. Character 2: Body system: [S]: Lower Joints [Q]: Lower Bones For example, the body system (Character 2) identifies the general anatomical region involved in the procedure. There are 31 body systems in ICD-10-PCS for the Medical and Surgical Section (character 0), however all entries to AJRR qualify as “S” or “Q” Character 3: Operations (most often used with joint replacements and revisions include the following)
Replacement [R]: 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 Supplement [U]: Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part Removal [P]: Taking out or off a device from a body part Revision [W]: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device.
5
Extirpation [C]: Taking or cutting out solid matter from a body part
Character 4: Body part (in our case, this will be for hip or knee) For 0SR (Lower Joint Replacement) 9: Hip Joint, Right B: Hip Joint, Left A: Hip Joint, Acetabular Surface, Right E: Hip Joint, Acetabular Surface, Left T: Knee Joint, Femoral Surface, Right U: Knee Joint, Femoral Surface, Left V: Knee Joint, Tibial Surface, Right W: Knee Joint, Tibial Surface, Left For 0QR (Lower Bones Replacement) 4: Acetabulum, Right 5: Acetabulum, Left 6: Upper Femur, Right 7: Upper Femur, Left 8: Femoral Shaft, Right 9: Femoral Shaft, Left B: Lower Femur, Right C: Lower Femur, Left D: Patella, Right F: Patella, Left G: Tibia, Right H: Tibia, Left Character 5 Approach 0 Open 3 Percutaneous 4 Percutaneous Endoscopic Character 6 Device 0 Synthetic Substitute, Polyethylene
1 Synthetic Substitute, Metal 2 Synthetic Substitute, Metal on Polyethylene 3 Synthetic Substitute, Ceramic 4 Synthetic Substitute, Ceramic on Polyethylene J Synthetic Substitute
6
B Resurfacing device 7 Autologous Tissue Substitute K Nonautologous Tissue Substitute
Character 7 Qualifier 9 Cemented A Uncemented Z No Qualifier The key to ICD-10-PCS is the first three characters of the code, which designates the body system and root operation. Each of the root operations is indexed into tables that identify valid additional characters. For example, the root operation 0SR with a body part of 9 (hip joint, right) allows only a surgical approach of 0 (open). The following are the root operations identified for joint replacements with a brief explanation: 0SR: Lower joint replacement (includes hip and knee joint) 0SP: Lower joint removal 0SU: Lower joint supplement 0SW: Lower joint revision 0QR: Lower bones, replacement (includes pelvic bones, acetabulum, upper
femur, femoral shaft, lower femur, patella, tibia) 0QP: Lower bones, removal 0QU: Lower bones, supplement 0QW: Lower bones, revision It is important to note that the hospital staff assigning the procedure codes are not at liberty to combine any of the choices listed in characters 1-7 at will; the “valid” combinations of characters appear by row in the ICD-10-PCS Tabular List published by CMS and available on their website. AJRR has identified those codes applicable to hip and knee replacement procedures and they attached in Appendix II of this document.
ICD10-PCS Procedures A complete list of replacement, removal, supplement and revision triggering codes is provided in Appendix II. Mapping of ICD9-PCS to ICD10-PCS is provided in Appendix I.
7
Primary Total Hip and Knee Procedures
Additional Coding for Primary Joint Replacement Procedures
The ICD-10-PCS root operation for total or partial hip or knee replacements is replacement, which is defined as “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.” The body part either will be right or left hip and knee joints. The approach will be open. If the procedure is performed on the right and left hip or knee joints, then two separate procedures are assigned to show the bilateral procedure.
The following are the choices for the device (character 6):
0 Synthetic Substitute, Polyethylene 1 Synthetic Substitute, Metal 2 Synthetic Substitute, Metal on Polyethylene 3 Synthetic Substitute, Ceramic 4 Synthetic Substitute, Ceramic on Polyethylene J Synthetic Substitute B Resurfacing device 7 Autologous Tissue Substitute K Nonautologous Tissue Substitute
For the qualifier (character 7), the choices include cemented, uncemented, or no qualifier. For example, a left total hip arthroplasty using a cemented stem and a metal-on-plastic articulating surface is classified to code 0SRB029.
Replacement includes taking out the body part (e.g., hip joint). According to the ICD-10-PCS Official Guidelines for Coding and Reporting, “Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are also not coded separately. Example: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately”.
Resurfacing maps to Supplement Operation Code
If the objective of the procedure is to reinforce or augment a previously replaced body part, the root operation of supplement is used, and this is defined as “putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part.” Putting in a new acetabular liner would be an example of this type of procedure. Several procedures fall into the supplement classification and, for example, include:
8
0SU90BZ Supplement Right Hip Joint with Resurfacing Device, Open Approach 0SUA0BZ Supplement Right Hip Joint, Acetabular Surface with Resurfacing
Device, Open Approach 0SUB0BZ Supplement Left Hip Joint with Resurfacing Device, Open Approach 0SUE0BZ Supplement Left Hip Joint, Acetabular Surface with Resurfacing Device,
Open Approach 0SUR0BZ Supplement Right Hip Joint, Femoral Surface with Resurfacing Device,
Open Approach 0SUS0BZ Supplement Left Hip Joint, Femoral Surface with Resurfacing Device,
Open Approach
Hip Hemi-Arthoplasty and Partial HIP (ICD9-PCS 81.52)
Partial hips (also known as Hemiarthroplasty) are typically conducted to repair a fracture of the head of the femur or acetabulum. These are coded as replacement procedures however they are coded to the specific portion of the joint replaced. Codes applicable include 0SRA0XY and 0SRE0XY for acetabulum and 0SRS0XY, OSRS for femoral surface. X= 0, 1,,3,J Note that for femoral surface 0=Synthetic substitute, polyethylene is not valid.
Y= A,9,Z
Examples:
0SRA07Z Replacement of Right Hip Joint, Acetabular Surface with Autologous Tissue Substitute, Open Approach
0SRE0JF Replacement of Right Hip Joint, Acetabular Surface with Synthetic Substitute, Metal, Open Approach
0SRR0JF Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Metal, Open Approach
0SRR0JG Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Ceramic, Open Approach
Using the Revision Operation Code
The definition for the Revision root operation provided in the 2014 ICD-10-PCS Reference Manual is “Correcting, to the extent possible, a malfunctioning or displaced device.” The root operation “Revision” is coded when the objective of the procedure is to correct the position or function of a previously placed device, without taking the entire device out and putting in a
9
whole new device in its place. Revision can include correcting a malfunctioning device by taking out and/or putting in part, but not all, of the device.
Example procedures include: repositioning of Swan-Ganz catheter in superior vena cava, taking out loose screw and putting larger screw in fracture repair plate, right fibula, revision of left hip replacement with readjustment of the prosthesis, and adjustment of the position of the pacemaker.
Those procedures coded as revisions for hip and knee include the small subset of codes that designate a replacement of select implanted components such as acetabular liner. Examples of valid codes using the “W” position 3 Revision operation code follow directly below.
0SW90JZ Revision of Synthetic Substitute in Right Hip Joint, Open Approach
0SWB0JZ Revision of Synthetic Substitute in Left Hip Joint, Open Approach
Note that replacement of tibial surface with liner is coded as a removal and supplement procedure pair.
0SPC09Z Removal of liner from Right Knee Joint, Open Approach
With
0SUV09Z Supplement Right Knee Joint, Tibial Surface with Liner, Open Approach
0SPD09Z Removal of liner from Left Knee Joint, Open Approach
With
0SUW09Z Supplement Left Knee Joint, Tibial Surface with Liner, Open Approach
Reporting Codes Previously Referred to as Revisions in ICD9-PCS For the revision of joint replacements, the appropriate code assignment will depend on the intent of the procedure. If the objective is to adjust the device, then the appropriate root operation is revision, which is defined as “correcting, to the extent possible, a malfunctioning or displaced device.” If the objective is to remove and replace the device, then two root operations are now required in ICD-10-PCS, a replacement procedure and removal procedure. In other words, one code is assigned for the removal of the device used in the previous replacement procedure, and one code is assigned for the placement of a new device. AJRR will require submission of both the removal and replacement procedures to accurately identify what aspects of the primary procedure have changed.
Example 1: Total Revision of Right Knee Replacement
10
The patient had a right total knee replacement performed nine years ago and now presents for a revision of the right total knee replacement. During surgery, the surgeon replaced the femoral, tibial, and patellar components in order to take advantage of the new more durable prosthetic components that were not available when the patient originally had his right knee replaced.
In ICD-9-CM, the alphabetic main term entry “Revision, sub terms knee replacement, total (all components)” identifies code 00.80. The code descriptor for 00.80 is “Revision of knee replacement, total (all components)” and is categorized under 00.8, “other knee and hip procedures”. ICD-9-CM also provides codes for revision of tibial component only (00.81), revision of femoral component only (00.82), and revision of patellar component only (00.83). If revision of two knee components is performed then the coding professional would code the appropriate two component codes. ICD-9-CM does not differentiate laterality. Therefore, the code would be the same if performed on the left knee rather than the right knee. No additional code is assigned to remove the original knee prosthesis.
In ICD-10-PCS the root operation for this procedure is “Replacement” as the objective of the procedure is to put in synthetic material that physically takes the place and function of the previously placed prosthesis. The Index main term entry is “Replacement, Joint, Knee, Right” which directs the coding professional to Table 0SR. The ICD-10-PCS code for this procedure is 0SRC0JZ. Similar to ICD-9-CM, ICD-10-PCS differentiates a total replacement versus replacement of only some of the knee components. In ICD-10-PCS the component(s) of the knee, as well as laterality, being replaced are captured by the fourth character, body part, of the code. Therefore, unlike ICD-9-CM, ICD-10-PCS captures whether the procedure was performed on the left versus the right knee. An additional code for Removal of the original prosthesis is also required in ICD-10-PCS (0SPC0JZ).
Appendix 1 ICD9-PCS to ICD10-PCS and CPT mapping table If the primary ICD10-PCS procedure code assigned to a patient matches one of the codes listed below the AJRR Level I and Level II data (when available) shall be extracted from the electronic medical record and submitted to the AJRR using the file format.
11
Description
ICD9-CM code Description ICD10 combinations
CPT CODES
ICD10 CODE
THA 81.51 Total hip replacement
0SR90xx – Replacement of Right Hip Joint with Synthetic Substitute, Open Approach 0SRB0xx – Replacement of Left Hip Joint with Synthetic Substitute, Open Approach 27130
0SR90xx 0SRB0xx
Hemiarthroplasty 81.52
Partial hip replacement / Hemi-arthroplasty Unipolar or bipolar femoral head Note that this procedure only replaces the femoral head and not the acetabulum. Typically used for femoral fractures.
0SRR0xx - Femoral Head Surface Right 0SRS0xx - Femoral Head Surface Left 27125
0SRR0xx 0SRS0xx
Revision Hip Replacement 81.53
Revision of hip replacement not otherwise specified
0SW90xx (Right Hip) 0SWB0xx (Left Hip) 27134
0SW90xx 0SWB0xx
80.05 Arthrotomy for removal of prosthesis of hip
0SP90xx (Removal of Prosthesis (Right Hip) 0SPB0xx (Removal of Prosthesis Left hip) 27091
0SP90xx 0SPB0xx
00.70 Revision of hip replacement, both acetabular and femoral
0SR90xx (Hip Joint Right), With 0SP90JZ 0SRB0xx (Hip Joint Right), With 0SPB0JZ 27134
0SR90xx With 0SP90JZ 0SRB0xx With 0SPB0JZ
12
00.71 Revision of hip replacement, acetabular component
0SRA0xx (Right Hip Joint Acetabular Surface), with 0SP90JZ 0SRE0xx (Left Hip Joint Acetabular Surface) , with 0SPB0JZ 27137
0SRA0xx With 0SP90JZ 0SRE0xx With 0SPB0JZ
00.72 Revision of hip replacement, femoral component
0SRR0xx (Right Hip Joint Femoral Surface), with 0SP90JZ 0SRS0xx (Left Hip Joint Femoral Surface) with 0SPB0JZ 27138
0SRR0xx With 0SP90JZ 0SRS0xx With 0SPB0JZ
00.73
Revision of hip replacement, acetabular liner and/or femoral head only
0SU90xx (Supplement Hip Joint Right with liner) 0SUA0xx (Hip Joint Right acetabular surface with liner) 0SUR0xx (Supplement Hip Joint Right, Femoral surface with liner) with 0SP909Z (Removal of Liner Right Hip Joint) 0SP90JZ )Removal of synthetic substitute Right Hip Joint 0SUB0xx (Hip Joint Left Supplement with Liner) 0SUE0xx (Hip Joint Left acetabular surface with liner) 27134
0SU90xx 0SUA0xx 0SUR0xx With 0SP909Z or 0SP90JZ 0SUB0xx 0SUE0xx 0SUS0xx
13
0SUS0xx (Hip Joint Left, femoral surface with liner) With 0SPB09Z (Removal of Synthetic Substitute from Left Hip Joint) 0SPB0JZ Removal of synthetic substitute Left Hip Joint Note that the device character 6 will include details on the type of device used.
With 0SPB09Z Or 0SPB0JZ
This procedure does not have a corresponding ICD10-PCS code. (Coding is custom for normalization from ICD9 to ICD10) 00.74
Revision of hip bearing surface Note for normalization and to reduce confusion between removal and replacement of the entire hip system this is being coded, only to normalize, to Replacement of Right/Left Hip acetabular surface OSRE0XX – Left 0SRA0XX – Right
0SRA0xx - Replacement of right hip joint, acetabular surface 0SRE0xx - Replacement of left hip joint, acetabular surface 27137
0SRA0xx 0SRE0xx
Hip Resurfacing 00.85
Resurfacing hip, total, acetabulum and femoral head Note that CMS decided that since the effort is to conserve as much bone as possible that resurfacing should remain a supplement operation and also
0SUR0Bx - Supplement Right Hip Joint – Femoral surface with Resurfacing device, With 0SUA0Bx - Supplement Right Hip – Acetabular surface with resurfacing device.) 27130
0SUB0Bx 0SUA0Bx 0SUS0Bx 0SUE0Bx
14
differentiates the procedure from a total hip.
0SUS0Bx - Supplement Left Hip Joint, Femoral Surface with Resurfacing Device 0SUE0Bx -Supplement Left Hip Joint with acetabular surface with resurfacing device Note the B in character position 6 is defined by CMS as "Resurfacing Device".
00.86 Resurfacing hip, partial, femoral head
0SUR0Bx (Supplement right hip joint, femoral surface with resurfacing device. 0SUS0Bx (Supplement left hip joint, femoral surface with resurfacing device. 27125
0SUR0Bx 0SUS0Bx
00.87 Resurfacing hip, partial, acetabulum
0SUA0Bx - (Supplement Right Hip Joint Acetabular Surface with resurfacing device), 0SUE0Bx (Supplement Left Hip Joint, Acetabular surface with resurfacing device.) 27125
0SUA0Bx 0SUE0Bx
Total Knee Arthroplasty
81.54 Total knee replacement
0SRD0xx - Replacement of Left Knee Joint 0SRC0xx - Replacement of Right Knee Joint 27447
0SRD0xx 0SRC0xx
80.06 Removal of Prosthesis Knee 0SPB0xx - Right Knee 0SPC0xx - Left Knee 27091
0SPB0xx 0SPC0xx
Patellar Resurfacing
No ICD9 Code
0SUD09C (Supplement Left Knee Joint with liner, Patellar Surface) 27438
0SUD09C 0SUC09C
15
Or 81.96 Other repair of joint
0SUC09C (Supplement Right Knee joint with liner, Patellar Surface)
Patellar Resurfacing
No ICD9 Code
0QRF0JZ (Replacement of Left Patellar with synthetic substitute) 0QRD0JZ (Replacement of Right Patellar with synthetic substitute ) With 0SPC09Z (Removal of liner from right knee joint.) Or 0SPD09Z (Removal of liner from right knee joint.) 27438
0QRF0JZ With 0SPC09Z 0QRD0JZ With 0SPD09Z
Other repair, knee 81.47 Other repair, knee
Eliminated from AJRR triggering codes for ICD10 0SQC0XX
Revision Knee Replacement 81.55
Revision total knee replacement
0SWC0xx - Revision of synthetic substitute Right Knee joint 0SWD0xx - Revision of synthetic substitute Left Knee Joint 27487
0SWC0xx 0SWD0xx
0.80 Revision of knee replacement, all components
0SRC0xx (Replacement of Right Knee Joint with Synthetic substitute), With 0SPC0JZ (Removal of synthetic substitute Right Knee Joint)
0SRC0xx With 0SPC0JZ 0SRD0xx With 0SPD0JZ
16
0SRD0xx (Replacement of Left Knee Joint with Synthetic substitute), With 0SPD0JZ (Removal of synthetic substitute Left Knee Joint)
0.81
Revision of knee replacement, tibial component including tibial insert
0SRV0JZ (Replacement of Right Knee Joint, Tibial surface with synthetic substitute) With 0SPC0JZ Removal of synthetic substitute Right Knee Joint 0SRW0xx (Replacement of Left Knee Joint, Tibial surface with synthetic substitute) With 0SPD0JZ Removal of synthetic substitute Left Knee Joint For replacement of tibial insert bearing only 0SUV09Z (Supplement Right Knee Joint, Tibial Surface with Liner, Open Approach)
With
0SPC09Z (Removal of liner from Right Knee Joint, Open Approach)
27486
0SRV0JZ With 0SPC0JZ 0SRW0JZ With 0SPD0JZ 0SUV09Z With 0SPC09Z 0SUW09Z With 0SPD09Z
17
0SUW09Z (Supplement Left Knee Joint, Tibial Surface with Liner, Open Approach)
With
0SPD09Z (Removal of liner from Left Knee Joint, Open Approach
0.82
Revision of knee replacement, femoral component
0SRT0JZ (Replacement Right Knee Joint, Femoral Surface with Synthetic Substitute.) 0SUC0JZ (Supplement Right Knee Joint with Synthetic Substitute) 0SUT09Z (Supplement Right Knee Joint, Femoral Surface with Liner) With 0SPC09Z (Removal of liner right knee joint) 0SPC0JZ (Removal of synthetic substitute from Right Knee Joint) 0SRU0JZ (Replacement Left Knee Joint, Femoral Surface with Synthetic Substitute.) 0SUD0JZ (Supplement Left Knee Joint with Synthetic Substitute) 0SUU09Z (Supplement Left Knee Joint, Femoral Surface with Liner) With 27486
0SRT0JZ 0SUC0JZ 0SUT09Z With 0SPC09Z 0SPC0JZ 0SRU0JZ 0SUD0JZ 0SUU09Z with 0SPD09Z 0SPD0JZ
18
0SPD09Z (Removal of liner left knee joint) 0SPD0JZ (Removal of synthetic substitute from Left Knee Joint)
0.83
Revision of knee replacement, patellar component
0QRD0JZ (Replacement of Right Patella with Synthetic substitute 0QUD0JZ Supplement of Right Patella with Synthetic substitute 0SUC09C - Supplement Right Knee Joint with Liner, Patellar Surface With 0QPD0JZ – Removal of Synthetic Substitute from Right Patella 0QRF0JZ (Replacement of Left Patella with Synthetic substitute 0QUF0JZ Supplement of Left Patella with Synthetic substitute 0QPF0JZ – Removal of Synthetic Substitute from Left Patella 27486
0QRD0JZ 0QUD0JZ 0SUC09C With 0QPD0JZ 0QRF0JZ 0QUF0JZ With 0QPF0JZ
0.84
Revision of knee replacement, isolated revision of tibial insert
0SUV09Z – Supplement Right Knee Joint, Tibial surface with Liner With 0SPC09Z – Removal of liner from Right Knee Joint 0SUW09Z – Supplement Left Knee Joint, Tibial Surface with Liner 27486
0SUV09Z With 0SPC09Z 0SUW09Z With
19
With 0SPD09Z Removal of liner from Left Knee Joint
0SPD09Z
Unicondylar Knee
New to ICD-10 No ICD-9 Code
Replacement of one condyle of the knee with a femoral and tibial component.
0SRT0JZ (Replacement of Right Knee joint, femoral surface with synthetic substitute femoral), 0SRU0JZ (Left Femoral) 27446
0SRT0JZ 0SRU0JZ
Other
Insertion of cement spacer 84.56 Insertion of cement spacer
0SHB08Z - Left Hip 0SH908Z - Right Hip 0SHC08Z – Right Knee 0SHD08Z - Left Knee 11981
0SHB08Z 0SH908Z 0SHC08Z 0SHD08Z
Removal of cement spacer 84.57 Removal of cement spacer
0SPC08Z - Right Knee 0SPD08Z -Left Knee 0SPB08Z – Left Hip 0SP908Z – Right Hip 11982
0SHC08Z 0SHD08Z 0SPB08Z 0SP908Z
20
Appendix II Replacement and Removal Triggering Codes
Primary Procedures
0SR907Z Replacement of Right Hip Joint with Autologous Tissue Substitute, Open Approach, Unspecified
0SR902A Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Uncemented
0SR902Z Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Unspecified
0SR9019 Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach, Cemented
0SR901A Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach, Uncemented
0SR901Z Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach, Unspecified
0SR90JZ Replacement of Right Hip Joint with Synthetic Substitute, Open Approach, Unspecified
0SR90J9 Replacement of Right Hip Joint with Synthetic Substitute, Open Approach, Cemented
0SR9029 Replacement of Right Hip Joint with Synthetic Substitute, Metal on Polyethylene, Open Approach, cemented
0SR90JA Replacement of Right Hip Joint with Synthetic Substitute, Open Approach, Uncemented
0SR903Z Replacement of Right Hip Joint with Ceramic Substitute, Open Approach, Unspecified
0SR9039 Replacement of Right Hip Joint with Ceramic Synthetic Substitute, Open Approach, Cemented
0SR903A Replacement of Right Hip Joint with Ceramic Synthetic Substitute, Open Approach, Uncemented
21
0SR904A Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Uncemented
0SR904Z Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Unspecified
0SR9049 Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Cemented
0SR90KZ Replacement of Right Hip Joint with Nonautologous Tissue Substitute, Open Approach, Unspecified
0SRA00Z Replacement of Right Hip Joint, Acetabular Surface with
Polyethylene Synthetic Substitute, Open Approach, Unspecified 0SRA009 Replacement of Right Hip Joint, Acetabular Surface with
Polyethylene Synthetic Substitute, Open Approach, Cemented 0SRA00A Replacement of Right Hip Joint, Acetabular Surface with
Polyethylene Synthetic Substitute, Open Approach, Cemented 0SRA07Z Replacement of Right Hip Joint, Acetabular Surface with
Autologous Tissue Substitute, Open Approach 0SRA01A Replacement of Right Hip Joint, Acetabular Surface with Metal
Synthetic Substitute, Open Approach, Uncemented 0SRA019 Replacement of Right Hip Joint, Acetabular Surface with Metal
Synthetic Substitute, Open Approach, Cemented 0SRA01Z Replacement of Right Hip Joint, Acetabular Surface with Metal
Synthetic Substitute, Open Approach, Unspecified 0SRA039 Replacement of Right Hip Joint, Acetabular Surface with Ceramic
Synthetic Substitute, Open Approach, Cemented 0SRA03A Replacement of Right Hip Joint, Acetabular Surface with Ceramic
Synthetic Substitute, Open Approach, Uncemented 0SRA03Z Replacement of Right Hip Joint, Acetabular Surface with Ceramic
Synthetic Substitute, Open Approach, Unspecified 0SRA0JZ Replacement of Right Hip Joint, Acetabular Surface with
Synthetic Substitute, Open Approach
22
0SRA0KZ Replacement of Right Hip Joint, Acetabular Surface with Nonautologous Tissue Substitute, Open Approach
0SRB029 Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Cemented
0SRB02A Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Uncemented
0SRB07Z Replacement of Left Hip Joint with Autologous Tissue Substitute, Open Approach
0SRB02Z Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach, Unspecified
0SRB039 Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Open Approach, Cemented
0SRB03A Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Open Approach, Uncemented
0SRB03Z Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Open Approach, Unspecified
0SRB049 Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Cemented
0SRB04A Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Uncemented
0SRB04Z Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach, Unspecified
0SRB019 Replacement of Left Hip Joint with Metal Synthetic Substitute, Open Approach, Cemented
0SRB01A Replacement of Left Hip Joint with Metal Synthetic Substitute, Substitute, Open Approach, Uncemented
0SRB01Z Replacement of Left Hip Joint with Metal Synthetic Substitute, Substitute, Open Approach, Unspecified
0SRB0J9 Replacement of Left Hip Joint Synthetic Substitute, Open Approach, Cemented
23
0SRB0JA Replacement of Left Hip Joint Synthetic Substitute, Open Approach, Uncemented
0SRB0JZ Replacement of Left Hip Joint with Synthetic Substitute, Open Approach, Unspecified
0SRB0KZ Replacement of Left Hip Joint with Nonautologous Tissue Substitute, Open Approach
0SRC07Z Replacement of Right Knee Joint with Autologous Tissue Substitute, Open Approach, Unspecified
0SRC0JZ Replacement of Right Knee Joint with Synthetic Substitute, Open Approach
0SRC0KZ Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach
0SRC0J9 Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach, Uncemented
0SRC0JA Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach, Cemented
0SRD07Z Replacement of Left Knee Joint with Autologous Tissue
Substitute, Open Approach 0SRD0JZ Replacement of Left Knee Joint with Synthetic Substitute, Open
Approach 0SRD0KZ Replacement of Left Knee Joint with Nonautologous Tissue
Substitute, Open Approach 0SRD0J9 Replacement of Left Knee Joint with Nonautologous Tissue
Substitute, Open Approach, Uncemented 0SRD0JA Replacement of Left Knee Joint with Nonautologous Tissue
Substitute, Open Approach, Cemented 0SRE07Z Replacement of Left Hip Joint, Acetabular Surface with
Autologous Tissue Substitute, Open Approach
24
0SRE0JZ Replacement of Left Hip Joint, Acetabular Surface with Synthetic Substitute, Open Approach
0SRE0KZ Replacement of Left Hip Joint, Acetabular Surface with Nonautologous Tissue Substitute, Open Approach
0SRE01A Replacement of Left Hip Joint, Acetabular Surface with Metal Synthetic Substitute, Open Approach, Uncemented
0SRE019 Replacement of Left Hip Joint, Acetabular Surface with Metal Synthetic Substitute, Open Approach, Cemented
0SRE01Z Replacement of Left Hip Joint, Acetabular Surface with Metal Synthetic Substitute, Open Approach, Unspecified
0SRE039 Replacement of Left Hip Joint, Acetabular Surface with Ceramic Synthetic Substitute, Open Approach, Cemented
0SRE03A Replacement of Left Hip Joint, Acetabular Surface with Ceramic Synthetic Substitute, Open Approach, Uncemented
0SRE03Z Replacement of Left Hip Joint, Acetabular Surface with Ceramic Synthetic Substitute, Open Approach, Unspecified
0SRE0J9 Replacement of Left Hip Joint, Acetabular Surface with Synthetic Substitute, Open Approach, Cemented
0SRE0JA Replacement of Left Hip Joint, Acetabular Surface with Synthetic Substitute, Open Approach, Uncemented
0SRE009 Replacement of Left Hip Joint, Acetabular Surface with Polyethylene Synthetic Substitute, Open Approach, Cemented
0SRE00A Replacement of Left Hip Joint, Acetabular Surface with Polyethylene Synthetic Substitute, Open Approach, Uncemented
0SRE00Z Replacement of Left Hip Joint, Acetabular Surface with Polyethylene Synthetic Substitute, Open Approach, Unspecified
0SRR07Z Replacement of Right Hip Joint, Femoral Surface with Autologous
Tissue Substitute, Open Approach 0SRR01Z Replacement of Right Hip Joint, Femoral Surface with Metal
Synthetic Substitute, Open Approach, Unspecified
25
0SRR03Z Replacement of Right Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Unspecified
0SRR019 Replacement of Right Hip Joint, Femoral Surface with Metal Synthetic Substitute, Open Approach, Cemented
0SRR01A Replacement of Right Hip Joint, Femoral Surface with Metal Synthetic Substitute, Open Approach, Uncemented
0SRR039 Replacement of Right Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Cemented
0SRR03A Replacement of Right Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Uncemented
0SRR0J9 Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Cemented
0SRR0JA Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Uncemented
0SRR0JZ Replacement of Right Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach
0SRR0KZ Replacement of Right Hip Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach
0SRS07Z Replacement of Left Hip Joint, Femoral Surface with Autologous
Tissue Substitute, Open Approach 0SRS01Z Replacement of Left Hip Joint, Femoral Surface with Synthetic
Substitute, Metal, Open Approach 0SRS03Z Replacement of Left Hip Joint, Femoral Surface with Synthetic
Substitute, Ceramic, Open Approach 0SRS0JZ Replacement of Left Hip Joint, Femoral Surface with Synthetic
Substitute, Open Approach 0SRS019 Replacement of Left Hip Joint, Femoral Surface with Metal
Synthetic Substitute, Open Approach, Cemented 0SRS01A Replacement of Left Hip Joint, Femoral Surface with Metal
Synthetic Substitute, Open Approach, Uncemented
26
0SRS039 Replacement of Left Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Cemented
0SRS03A Replacement of Left Hip Joint, Femoral Surface with Ceramic Synthetic Substitute, Open Approach, Uncemented
0SRS0J9 Replacement of Left Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Cemented
0SRS0JA Replacement of Left Hip Joint, Femoral Surface with Synthetic Substitute, Open Approach, Uncemented
0SRS0KZ Replacement of Left Hip Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach
0SRT0J9 Replacement of Right Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach, Cemented
0SRT07Z Replacement of Right Knee Joint, Femoral Surface with Autologous Tissue Substitute, Open Approach, Unspecified
0SRT0JA Replacement of Right Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach, Uncemented
0SRT0JZ Replacement of Right Knee Joint, Femoral Surface with Synthetic Substitute, Open Approach
0SRT0KZ Replacement of Right Knee Joint, Femoral Surface with Nonautologous Tissue Substitute, Open Approach
0SRU07Z Replacement of Left Knee Joint, Femoral Surface with
Autologous Tissue Substitute, Open Approach 0SRU0JZ Replacement of Left Knee Joint, Femoral Surface with Synthetic
Substitute, Open Approach, Unspecified 0SRU0KZ Replacement of Left Knee Joint, Femoral Surface with
Nonautologous Tissue Substitute, Open Approach 0SRU0J9 Replacement of Left Knee Joint, Femoral Surface with Synthetic
Substitute, Open Approach, Cemented 0SRU0JA Replacement of Left Knee Joint, Femoral Surface with Synthetic
Substitute, Open Approach, Uncemented
27
0SRV07Z Replacement of Right Knee Joint, Tibial Surface with Autologous
Tissue Substitute, Open Approach 0SRV0JZ Replacement of Right Knee Joint, Tibial Surface with Synthetic
Substitute, Open Approach 0SRV0KZ Replacement of Right Knee Joint, Tibial Surface with
Nonautologous Tissue Substitute, Open Approach 0SRV0JA Replacement of Right Knee Joint, Tibial Surface with Synthetic
Substitute, Open Approach, Uncemented 0SRV0J9 Replacement of Right Knee Joint, Tibial Surface with Synthetic
Substitute, Open Approach, Cemented 0SRW07Z Replacement of Left Knee Joint, Tibial Surface with Autologous
Tissue Substitute, Open Approach 0SRW0JZ Replacement of Left Knee Joint, Tibial Surface with Synthetic
Substitute, Open Approach 0SRW0KZ Replacement of Left Knee Joint, Tibial Surface with
Nonautologous Tissue Substitute, Open Approach 0SRW0JA Replacement of Left Knee Joint, Tibial Surface with Synthetic
Substitute , Open Approach, Uncemented 0SRW0J9 Replacement of Left Knee Joint, Tibial Surface with Synthetic
Substitute , Open Approach, Cemented 0SU90BZ Supplement Right Hip Joint with Resurfacing Device, Open
Approach 0SU907Z Supplement Right Hip Joint with Autologous Tissue Substitute,
Open Approach 0SU909Z Supplement Right Hip Joint with Liner, Open Approach 0SU90JZ Supplement Right Hip Joint with Synthetic Substitute, Open
Approach
28
0SU90KZ Supplement Right Hip Joint with Nonautologous Tissue Substitute, Open Approach
0SUA0BZ Supplement Right Hip Joint, Acetabular Surface with Resurfacing
Device, Open Approach 0SUA09Z Supplement Right Hip Joint, Acetabular Surface with Liner, Open
Approach 0SUB0BZ Supplement Left Hip Joint with Resurfacing Device, Open
Approach 0SUB09Z Supplement Left Hip Joint with Liner, Open Approach 0SUB0JZ Supplement Left Hip Joint Synthetic Substitute, Open Approach 0SUB07Z Supplement Left Hip Joint Autologous Tissue Substitute, Open
Approach 0SUB0KZ Supplement Left Hip Joint Nonautologous Tissue Substitute,
Open Approach 0SUC09C Supplement Right Knee Joint with Liner, Patellar Surface, Open
Approach 0SUC0JZ Supplement Right Knee Joint with Synthetic Substitute, Open
Approach 0SUC09Z Supplement Right Knee Joint with Liner, Open Approach 0SUC0KZ Supplement Right Knee Joint with Nonautologous Tissue
Substitute, Open Approach 0SUC07Z Supplement Right Knee Joint with Autologous Tissue Substitute,
Open Approach 0SUD09C Supplement Left Knee Joint with Liner, Patellar Surface, Open
Approach 0SUD0JZ Supplement Left Knee Joint with Synthetic Substitute, Open
Approach
29
0SUD09Z Supplement Left Knee Joint with Liner, Open Approach 0SUD0KZ Supplement Left Knee Joint with Nonautologous Tissue
Substitute, Open Approach 0SUD07Z Supplement Left Knee Joint with Autologous Tissue Substitute,
Open Approach 0SUE0BZ Supplement Left Hip Joint, Acetabular Surface with Resurfacing
Device, Open Approach 0SUE09Z Supplement Left Hip Joint, Acetabular Surface with Liner, Open
Approach 0SUF0JZ Supplement Left Patella with Synthetic Substitute, Open
Approach 0SUR0BZ Supplement Right Hip Joint, Femoral Surface with Resurfacing
Device, Open Approach 0SUR09Z Supplement Right Hip Joint, Femoral Surface with Liner, Open
Approach 0SUS0BZ Supplement Left Hip Joint, Femoral Surface with Resurfacing
Device, Open Approach 0SUS09Z Supplement Left Hip Joint, Femoral Surface with Liner, Open
Approach 0SUT09Z Supplement Right Knee Joint, Femoral Surface with Liner, Open
Approach 0SUU09Z Supplement Left Knee Joint, Femoral Surface with Liner, Open
Approach
30
0SUV09Z Supplement Right Knee Joint, Tibial Surface with Liner, Open
Approach 0SUW09Z Supplement Left Knee Joint, Tibial Surface with Liner, Open
Approach 0SWC0JZ Revision of Synthetic Substitute in Right Knee Joint, Open
Approach 0SWC09Z Revision of Liner in Right Knee Joint, Open Approach 0SWD0JZ Revision of Synthetic Substitute in Left Knee Joint, Open
Approach 0SWD09Z Revision of Liner in Left Knee Joint, Open Approach 0QRF0JZ Replacement of Left Patella with Synthetic Substitute, Open
Approach 0QRD0JZ Replacement of Right Patella with Synthetic Substitute, Open
Approach 0QUF0JZ Supplement Left Patella with Synthetic Substitute, Open
Approach 0QUD0JZ Supplement Right Patella with Synthetic Substitute, Open
Approach 0SW90JZ Revision of Synthetic Substitute in Right Hip Joint, Open
Approach 0SW909Z Revision of Liner in Right Hip Joint, Open Approach 0SW90BZ Revision of Resurfacing Device in Right Hip Joint, Open Approach
31
0SWB0JZ Revision of Synthetic Substitute in Left Hip Joint, Open Approach 0SWB09Z Revision of Liner in Left Hip Joint, Open Approach 0SWB0BZ Revision of Resurfacing Device in Left Hip Joint, Open Approach Spacer Insertion Codes involved with implant of antibiotic or other joint spacers 0SHB08Z Insertion of spacer into left hip joint, open approach 0SH908Z Insertion of spacer into right hip joint, open approach 0SHC08Z Insertion of spacer into right knee joint, open approach 0SHD08Z Insertion of spacer into left knee joint, open approach Revision codes removals Note that these codes must have a corresponding replacement code from the list of operating procedures above.
Note that specifics on the materials, are not allowed in character positions 6 such as synthetic substitute polyethylene = 0. The only code allowed in position 6 is J. Specific body parts such as acetabular surface = A are not accepted for the removal procedures only the less specific right/left hip joint=9,B or right/left knee joint = 0,4
0SP90JZ Removal of Synthetic Substitute from Right Hip Joint, Open
Approach 0SP908Z Removal of Spacer from Right Hip Joint, Open Approach 0SP909Z Removal of Liner from Right Hip Joint, Open Approach 0SP90BZ Removal of Resurfacing Device from Right Hip Joint, Open
Approach 0SPB0JZ Removal of Synthetic Substitute from Left Hip Joint, Open
Approach 0SPB08Z Removal of Spacer from Left Hip Joint, Open Approach
32
0SPB09Z Removal of Liner from Left Hip Joint, Open Approach 0SPB0BZ Removal of Resurfacing Device from Left Hip Joint, Open
Approach 0SPC0JZ Removal of Synthetic Substitute from Right Knee Joint, Open
Approach 0SPC08Z Removal of Spacer from Right Knee Joint, Open Approach 0SPC09Z Removal of Liner from Right Knee Joint, Open Approach 0SPD0JZ Removal of Synthetic Substitute from Left Knee Joint, Open
Approach 0SPD09Z Removal of Liner from Left Knee Joint, Open Approach 0SPD08Z Removal of Spacer from Left Knee Joint, Open Approach 0QPF0JZ Removal of Synthetic Substitute from Left Patella, Open
Approach