ICD-10 Implementation

ICD-10 Impact on the Orthopaedic Surgeon
The current ICD-9 code sets, used in all U.S. health care settings, lack sufficient space to accommodate new procedures, disease processes, and detail (e.g., laterality, episode of care for injuries). Diagnosis coding under ICD-10-CM uses 3 to 7 digits and the number of codes available expands to 155,000. This chart shows an example of the alphanumeric breakdown.

Digit 1


Digit 2


Digits 3-7

Alpha or numeric

Decimal is used after the third character

Example: S52.131A - Displaced fracture of neck of right radius, initial encounter for closed fracture

Under ICD-10, fracture coding will be challenging for orthopaedic surgeons and coding professionals. For example, in searching for "humerus fracture" an ICD-10 code search will yield 1,284 codes. The ICD-10 search results in so many code descriptions to provide more detail. These are keywords to consider when searching ICD-10 in this example:

  • right or left
  • pathologic, stress, physeal, osteoporosis-related, Salter-Harris, or unspecified
  • initial or subsequent encounter
  • open or closed
  • displaced or non-displaced
  • 2-part, 3-part or 4-part
  • surgical neck or greater tuberosity
  • neoplastic
  • nonunion

The physician will need to document and provide coding staff with much more information about the patient's diagnosis under ICD-10. The next time you are coding for a fracture of the humerus, or for any other type of fracture, try coding the diagnosis for both ICD-9 and ICD-10. Develop your search using more information based on keywords as in the sample above. While you can use a book for searching ICD-9, you will need a computer program to effectively search ICD-10.

Financial Impact
Practices should plan for the potential of a significant financial impact on revenue following the conversion.

This cost is spread across six major areas:

  • education and training of staff/coders;
  • conducting an analysis of the impact on all business processes;
  • changing superbills;
  • added costs associated with increased documentation;
  • needed information technology system changes; and
  • changes in cash flow results from denied claims.