Total knee replacement (TKR) surgery is one of the most common major orthopedic procedures performed today. And, as part of the patient care team, skilled and talented coders and billers use ICD-10 codes to capture these TKR patients’ journeys.
More than 600,000 total knee replacement surgeries are performed each year in the U.S., a number that is expected to increase to 1,272,000 by 2025.1 As these numbers grow, physical therapy continues to be an integral part of patient journeys.
From the time patients identify pain and mobility issues to seeking non-surgical treatment, diagnosis insight, as well as pre- and post-op knee replacement treatment, ICD-10 codes track their care. They allow both small and large physical therapy clinics to follow patients from knee pain, through surgery, and into rehab and the road to optimal function and mobility.
In addition, billers and coders endeavor to optimize claim reimbursements with ICD-10 and strive to utilize tools that encourage positive patient engagement in our physical therapy clinics.
At the same time, efficient and successful ICD-10 tools create opportunities for excellent staff retention.
Decode the Total Knee Replacement Patient Journey with ICD-10
Many of you working in physical therapy with knee replacement patients are familiar with the ICD-10 Z codes.
The knee replacement aftercare billable specific ICD-10 code often used for reimbursement purposes is Z47.1. But, if the patient has ongoing issues with their knee replacement, even better Z codes are available.
For the presence of artificial knee joint with chronic pain, revision, or prosthesis failure, as examples, use Z96.65 codes. These codes allow for further specificity for right, left, bilateral, and unspecified artificial knee joints.
It is also important to consider treatment-specific ICD-10 codes to complement the Z codes noted above. Therapists need to assess the patient and determine what related impairments are present that need to be addressed in the plan of care.
Commonly used ICD-10 codes for total knee replacement treatment might include those for pain, effusion/swelling, stiffness/loss of motion, and gait abnormalities.
While including treatment diagnosis codes further supports the medical necessity of therapy services, you must check payer-specific guidelines and local coverage articles when choosing your diagnosis codes.
The Well-Coded ICD-10 Patient Journey Encourages Positive Patient Engagement
We know patient care for knee pain does not begin or end with knee replacement surgery. To complicate physical therapy billing matters, one knee might be replaced while the other has ongoing osteoporosis and is awaiting surgery.
To ensure specific and accurate knee replacement ICD-10 codes for physical therapy, we consider the etiology behind the knee pain such as osteoarthritis, posttraumatic degenerative joint disease, or rheumatoid arthritis.
Along with specialized EHR, accurate ICD-10 codes with high-level specificity illustrate the patients’ unique history. This documentation creates action items to further assist patients in completing their care plans.
With improved patient outcomes, the result is delighted therapists, satisfied patients, and a thriving business.
Streamline Revenue with Coding Automation
Effective ICD-10 coding tools help successfully process knee replacement physical therapy billing.
A growth industry, the global joint replacement market size was valued at $17.1 billion in 20202, with the largest revenue share of 46% in knee joint replacement. Due to an aging population and the prevalence of osteoporosis and rheumatoid arthritis, the global joint replacement market size is expected to grow by a (CAGR) of 3.4% from 2021 to 2028.
Notably, chronic pain after TKR is experienced by approximately 20% of patients3. This may negatively impact the patient’s quality of life, function and mobility.
Physical therapy following total knee replacement surgery is an identified recommended treatment protocol for improving postsurgical outcomes.4 Using a highly customizable and tailored outpatient physical therapy EMR and billing software can streamline billing processes and improve reimbursement.
Tools for Optimized Coding
Automated ICD-10 coding and billing success improves office morale and increases staff retention.
Net Health Therapy for Clinics EHR is the solution that makes ICD-10 coding and other billing/compliance tasks simpler through automation and by providing the billing team access to a fully customizable, configurable coding and compliance engine.
Front-end, back-end, billers, and coders are thrilled with the job scheduling, accounting, and automated optimal coding. It is all the outpatient therapy EMR and billing software you need in one package to maximize ICD-10 coding, improve reimbursement, increase patient engagement and provide outstanding staff with excellent tools.
Ultimate Guide to Therapist Productivity
Download this guide to help your team manage this crucial element of your rehab therapy operation.
1 The Journal of Rheumatology, Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample, April 2019
2 Grand View Research, Joint Replacement Market Size, Share & Trends Analysis Report By Product (Knees, Hips, Extremities), By Fixation Type, By End-use (Hospitals, Orthopedic Clinics), By Procedure, By Region, And Segment Forecasts, 2021 – 2028, July 2022
3 EFFORT Open Revies, Chronic pain after total knee arthroplasty, Aug 16, 2018
4 PTJ: Physical Therapy & Rehabilitation Journal, Physical Therapist Management of Total Knee Arthroplasty, June 16, 2020