Orthopedic coding requires precise laterality, fracture type, and episode-of-care detail. This page covers the most frequently used ICD-10-CM and CPT codes for orthopedic surgeons, sports medicine physicians, and musculoskeletal specialists practicing in the United States.
M17.11 (right knee) and M17.12 (left knee) are the primary codes for primary osteoarthritis. Always document laterality. For bilateral, use M17.0. Avoid M17.9 (unspecified) as it may trigger payer queries.
What 7th character is used for fracture initial encounters?
Use ‘A’ for the initial encounter for a closed fracture. ‘B’ is for open fractures (types I–III). ‘D’ is for subsequent encounters. ‘S’ is for sequela. The 7th character is mandatory — claims without it will be rejected.
What CPT code is used for knee replacement?
27447 is total knee arthroplasty (both components). 27446 is unicompartmental (partial). The distinction must match the operative report exactly.
Does M54.5 (low back pain) require additional codes?
M54.5 is billable as a standalone code. However, when low back pain is due to a specific condition (e.g., disc herniation M51.16, spinal stenosis M48.06), code the underlying condition first, with M54.5 as an additional code if not integral to the underlying condition.
How does OmniMD support orthopedic coding?
OmniMD’s Orthopedic EHR includes pre-built orthopedic note templates with integrated ICD-10 and CPT code libraries, reducing coding time and improving first-pass claim acceptance rates.
Streamline Your Orthopedics Practice with OmniMD
Purpose-built EHR, billing, and practice management for Orthopedics practices.
