EmailStiff total knee replacement (TKR) and stiffness post TKR
Publication Date: June 2018
ICD 10 AM Edition: Tenth edition
Query Number: 3357
We have a number of patients readmitted post Total Knee Replacement (TKR) with knee/TKR stiffness for manipulation.
We have had previous clinical/coding advice that a stiff TKR may be multifactorial (ie due to the actual prosthesis, due to the procedure in general, unknown reasons, patient not compliant with exercises etc) and therefore have been advised that we should be querying for the reason of stiffness before assigning a complication code.
With the updates to ACS 1904 Procedural complications with ICD-10-AM-Tenth Edition we would like to take this opportunity to confirm the correct code/codes to assign for documentation of stiff TKR and stiffness post TKR.
ACS 1904 Procedural complications overview criteria, points 2 and 3, instruct the coding of a procedural complication when:
'Certain conditions where the relationship is inherent in the diagnosis (e.g. infection or bleeding of a surgical wound, stoma or anastomosis, wound dehiscence, transfusion related acute lung injury) Conditions classified to T82-T85 for complications related to prosthetic devices, implants or grafts (e.g. mechanical complications, haematoma, pain, stenosis following insertion of prosthetic devices) (see Example 3) For a medical condition occurring during or following insertion of prosthetic devices but not classified to T82-T85, see Intraoperative/postoperative medical conditions below.'
1. Can VICC confirm whether either of these points can be applied to documentation of:
a) stiff TKR
b) stiffness post TKR
in order to assign a code for a procedural complication?
2. And if so, can you please confirm if the correct code assignment for scenarios a) and b) above is T84.89 Other specified complications following insertion of internal orthopaedic prosthetic devices, implants and grafts following index pathway Complication/orthopaedic/device, implant or graft/joint NEC?
Search Details
ACS 1904 Procedural complications
We have had previous clinical/coding advice that a stiff TKR may be multifactorial (ie due to the actual prosthesis, due to the procedure in general, unknown reasons, patient not compliant with exercises etc) and therefore have been advised that we should be querying for the reason of stiffness before assigning a complication code.
With the updates to ACS 1904 Procedural complications with ICD-10-AM-Tenth Edition we would like to take this opportunity to confirm the correct code/codes to assign for documentation of stiff TKR and stiffness post TKR.
ACS 1904 Procedural complications overview criteria, points 2 and 3, instruct the coding of a procedural complication when:
'Certain conditions where the relationship is inherent in the diagnosis (e.g. infection or bleeding of a surgical wound, stoma or anastomosis, wound dehiscence, transfusion related acute lung injury) Conditions classified to T82-T85 for complications related to prosthetic devices, implants or grafts (e.g. mechanical complications, haematoma, pain, stenosis following insertion of prosthetic devices) (see Example 3) For a medical condition occurring during or following insertion of prosthetic devices but not classified to T82-T85, see Intraoperative/postoperative medical conditions below.'
1. Can VICC confirm whether either of these points can be applied to documentation of:
a) stiff TKR
b) stiffness post TKR
in order to assign a code for a procedural complication?
2. And if so, can you please confirm if the correct code assignment for scenarios a) and b) above is T84.89 Other specified complications following insertion of internal orthopaedic prosthetic devices, implants and grafts following index pathway Complication/orthopaedic/device, implant or graft/joint NEC?
Search Details
ACS 1904 Procedural complications
Response
VICC confirms that ACS 1904 Procedural complications Overview section, dot points 2 and 3 apply to documentation of stiff TKR and stiffness post TKR because there is an inferred relationship between the stiffness and the prosthetic device.
In these cases, follow the Index pathway Complication/orthopaedic/device,implant or graft/joint NEC to assign T84.89 Other specified complications following insertion of internal orthopaedic prosthetic devices, implants and grafts and Index pathway Stiffness, joint/knee to assign M25.66 Stiffness of joint, not elsewhere classified, lower leg to add specificity.
In these cases, follow the Index pathway Complication/orthopaedic/device,implant or graft/joint NEC to assign T84.89 Other specified complications following insertion of internal orthopaedic prosthetic devices, implants and grafts and Index pathway Stiffness, joint/knee to assign M25.66 Stiffness of joint, not elsewhere classified, lower leg to add specificity.
