Z47.1: Joint Replacement Aftercare ICD 10 code
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Z47.1 is the ICD 10 code used for joint replacement aftercare that continues to be one of the more common post surgical treatment plans carried out by physical therapists. In 2021 alone, the American Joint Replacement Registry reported that 2.4 million hip and knee joint replacements were performed in the United States. This number, while large, fails to also take into account replacements performed on other joints such as the ankle, wrist, shoulder, elbow, toes and fingers, which means the number of Americans requiring aftercare for joint replacements yearly, is even greater.
When there is severe damage to the cartilage and/or bone of a joint, a partial or total joint replacement may be recommended. A total or partial joint replacement called a total or hemi-arthroplasty allows surgeons to replace the native bone and cartilage with a prosthetic joint. This is done to improve pain and function of the joint. Joint replacement can offer relief of symptoms like pain and stiffness in the joint and help restore more normal levels of function.
Physical therapy aftercare following joint replacement surgery is an essential component of a patient’s overall recovery.
Physical therapists providing joint replacement aftercare structure their plans of care to achieve several goals:
- Educate patients on how to maintain movement precautions and restrictions; on how to utilize assistive devices and adaptive equipment safely and effectively; on the purpose of physical therapy and how their participation in therapy both in the clinic and at home is vital to their recovery: (patient education, gait training, home management, home exercise program)
- Restore functional range of motion (stretching, joint mobilization, mobility exercises)
- Restore muscle strength, coordination and neuromuscular control to stabilize and control joint positions and to facilitate return to prior levels of function (therapeutic exercise, therapeutic and functional activities, neuromuscular re-education, gait training, NMES or Russian Stim)
- Normalize gait and movement patterns (gait training, neuromuscular re-education, biomechanics training, sensory feedback and biofeedback)
- Control postsurgical pain and inflammation (cryotherapy, electrical stimulation, ultrasound, laser therapy, soft tissue mobilization, cupping, IASTM, patient education, gentle movement and graded exercise)
- Help patients achieve return to work, leisure, home and recreational activities with minimal impairments (therapeutic exercise, therapeutic activities, work and sport-specific training, work hardening)
ICD 10 code Z47.1: Aftercare following joint replacement surgery
In order to submit billing codes to an insurance company for the treatment of a patient status post joint replacement, an appropriate ICD-10 code like Z47.1 must also be submitted. Orthopedic aftercare codes, which all fall under the tabular list Z47, were created to describe several orthopedic surgical conditions requiring continuing care thereafter (note, this code should not be used to describe aftercare of a fracture). This includes the code for aftercare following joint replacement surgery.
Z47 Orthopedic aftercare
- Z47.1 Aftercare following joint replacement surgery
- Z47.2 Encounter for removal of internal fixation device
- Z47.3 Aftercare following explantation of joint prosthesis
- Z47.31 Aftercare following explantation of shoulder joint prosthesis
- Z47.32 Aftercare following explantation of hip joint prosthesis
- Z47.33 Aftercare following explantation of knee joint prosthesis
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For this condition you may use code Z47.1 as a primary diagnosis code, however, there is a good chance there are additional codes that you should also include in your list that further describe the joint you are treating and impairments you are addressing. For example, the code Z96 (too nonspecific to be reimbursable) denotes the presence of “other functional implants.” If you look at this list you will find a code to describe the presence of a specific artificial joint.
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If you are treating a patient post right shoulder replacement you might include Z96.611, Presence of right artificial shoulder joint, in addition to Z47.1. If your patient is recovering from ankle replacement you might include Z96.662, Presence of left artificial ankle joint.
ICD10 codes describing the impairments you are treating are also important to include. For example, a patient who is having difficulty walking after hip replacement might need the code R26.2, difficulty in walking. A patient who is dealing with a lot of upper extremity weakness following elbow replacement may need the code R53.1, weakness.
One aspect of coding that is important to consider, when it comes to joint replacement aftercare, is when the patient is coming to see you relative to when they had their surgery. The code Z47.1 is most appropriate to use during the rehabilitation time-frame immediately after joint replacement surgery when the goal is to promote healing and recovery from the surgery itself.
There may be cases wherein a patient comes to see you to address impairments that you believe could be related to a previous joint replacement surgery or that the presence of an artificial joint is related to their symptoms but the patient has already undergone and completed physical therapy specifically to recover from the joint replacement procedure.
Under these circumstances it would be more appropriate to use the Z96 codes vs. Z47.1 to describe the presence of an artificial joint and impairment-specific codes that describe the impairments you will be addressing.
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Billing and documentation for aftercare following a joining replacement surgery
Billing for aftercare following joint replacement surgery follows the same rules as billing for other conditions. Be sure to review the definitions of your CPT codes to ensure you are selecting the most appropriate code to describe the interventions you provided. Documentation of medical necessity for physical therapy services using functional outcome measures, descriptions of impairments and functional limitations and evidence of their response to therapy interventions is also required in addition to the Z47.1 code.
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Having the right EHR/EMR software goes a long way in building confidence in your billing and documentation practices around Z47.1. TheraPlatform, an all-in-one EHR, practice management and teletherapy tool built especially for therapists can help. Sign up for a 30-day free trial with no credit card required. Cancel anytime.
More resources
- Physical therapy benchmarks
- Physical therapy billing
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
