Below is an example of a left total hip arthroplasty procedure coded using the current ICD-9-CM codes as well as the future ICD-10-CM and ICD-10-PCS codes that would be assigned for this procedure.

Preoperative diagnosis: Severe osteoarthritis, left hip

Postoperative diagnosis: Same

Procedure: Left total hip arthroplasty

Implant system used: Pinnacle by DePuy 300 series acetabular component, size 52, with 36 mm +4 inside diameter polyethylene liner, size 3 porous-coated hip stem Summit design, standard offset, with +5 36 mm Articuleze head ball

Procedure description:  The patient was brought to the operating room, given general endotracheal anesthetic, and positioned on the operating table in the left upright lateral position. The left lower extremity and pelvic area were covered with Betadine and draped with sterile drapes, stockingettes, and Ioban in the usual manner. 

After confirmation of correct side surgery and time-out, a direct lateral approach was made through the left hip. Dissection was carried through skin and subcutaneous tissue, and bleeders were clamped and coagulated. Fascia lata was incised in the direction of the skin incision, the trochanteric surface of the femur exposed. The anterior capsule was elevated with a portion of the vastus lateralis. The joint was incised, the capsule was elevated. The hip was dislocated, and the patient was found to have severe deformity of the femoral head. Initially the proximal femur was entered and reamed to a size 3 stem, then the femoral neck was divided using a prosthesis as a guide. The proximal femur was then broached beginning with the 2 broach and expanding to a 3 broach. A good fit and fill was obtained with the 3 broach, and the patient was well-fitted with a size 3 stem.  The calcar was planed smooth.

Attention was then turned to the acetabulum, retractors were placed anteriorly and posteriorly. The inferior capsule was released. There was no remaining normal bone in the acetabulum. The acetabulum was reamed beginning with a 46 mm reamer and expanding to a 52 reamer. We then elected to use a 52 mm porous coated cup. This was impacted into the acetabulum, oriented at 45 degrees in the horizontal, in approximately 20-25 degrees anteversion. A trial reduction was then accomplished using a 36 mm +5 hip ball with standard offset. X-rays taken intra-operatively reveal anatomical placement of the implants with anatomical restoration of leg length. At this point the final polyethylene liner was impacted. The porous-coated stem was driven to rest on the calcar, and all components reduced with the hip ball applied. Patient had excellent fixation to greater than 120 degrees with 30 degrees internal/external rotation and adduction without impingement or subluxation. She could hyperextend to 30 degrees internal and external rotation without impingement or subluxation. Throughout the procedure the wound was copiously irrigated with pulsatile lavage. Closure was accomplished over a Hemovac drain using #3 Vicryl to reattach the anterior capsule to the trochanteric surface of the femur. Fascia lata was closed with #3 Vicryl, subcutaneous tissue in multiple layers of 0 and 2-0 Monocryl and staples on the skin. Hemovac was placed on clamp. Total estimated intra-operative blood loss 300-400 cc. Cell saver was used.  Patient remained stable throughout. She was alert and well-oriented with good motor and sensory function in the recovery room after awake.

Codes Assigned
Listed in the table below is a comparison of the ICD-9-CM and ICD-10-CM diagnosis code for this procedure.

Note also that each digit of the ICD-10 diagnosis code is a specific identifier: M = Chapter 13-diseases of the musculoskeletal system and connective tissue; 16-19 = osteoarthritis, 16 = of the hip, and .9 = hip, unspecified.

Now review the second table below, which lists the ICD-9 procedure code and the ICD-10 procedure code. ICD-10-PCS is specific to the right or left joint replacement procedure.

In the ICD-10 index, start with the term Replacement, by body part, hip joint, left.  This will lead you to the appropriate anatomical region under the medical and surgical section of lower joints; replacement. Using the operative report, work through each of the remaining four characters to assign the appropriate ICD-10-PCS code for the procedure performed.

Like the ICD-10 diagnosis codes, each digit in the ICD-10-PCS column identifies a specific feature: 0 = medical and surgical; S = anatomical region, lower joints; R = replacement; B = body part, hip joint, left; 0 = open; J = synthetic substitute; and Z = no qualifier. 

The following are the links to access the latest version of ICD-10-CM and ICD-10-PCS.

http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm and http://www.cms.hhs.gov/ICD10/01m_2009_ICD10PCS.asp#TopOfPage

Lynn Cleasby is a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.