With not much time to go for October 1, 2013, there is no denying that now everyone is training eyes on ICD-10. However, in doing so, you should not ignore your ICD-9 coding options. Here's a scenario to help your understanding of ICD-9 codes:
Patient A comes to your office for treatment of severe, chronic pain in the right side of his back. The pain had started about 10 months ago. In the right lumbar multifidus muscle for pain relief, your interventional radiologist uses ultrasound guidance to administer two trigger point injections (TPIs). But then his chart notes only say that the patient had 'pack pain'.
You get the chart and also get to see your radiologist performed trigger point injections on other patients in the past, using 20552 and 76942. The most recent injections carried out on the other patients' backs were for myofascial pain.
Minus more specific diagnosis, you should assume that Patient A also has myofascial pain, and report one unit of 20552 with a diagnosis of 729.1?
Well, the answer here is no. Making assumptions does not support compliant coding. From a clinical standpoint, pain can be caused by various reasons. Even if the diagnosis seems obvious, coders are not clinicians and should never make presumptions.
If your radiologist did not specifically document myofascial pain or myalgia and you use one of those codes, you could land in trouble in case of a payer audit. Such mistakes are just the kind of thing that auditors watch out for. In its place, you may be required to report an unspecified code, such as 724.5.
Remember payers may not always accept 'unspecified' codes in assistance of a service; however some payers will reimburse for 724.5 for trigger point injections. As such, be sure to study your payer coverage policies well prior to determining if the diagnosis fits the payer's rules. As a coder, you should be aware of payer policies and LCDs to be able to convey that information to the physician.
Bear in mind that spot on medical coding requires that you select code based on the documentation you must never report a diagnosis code just because you are aware the payer will pay the service if you report that diagnosis.
Patient A comes to your office for treatment of severe, chronic pain in the right side of his back. The pain had started about 10 months ago. In the right lumbar multifidus muscle for pain relief, your interventional radiologist uses ultrasound guidance to administer two trigger point injections (TPIs). But then his chart notes only say that the patient had 'pack pain'.
You get the chart and also get to see your radiologist performed trigger point injections on other patients in the past, using 20552 and 76942. The most recent injections carried out on the other patients' backs were for myofascial pain.
Minus more specific diagnosis, you should assume that Patient A also has myofascial pain, and report one unit of 20552 with a diagnosis of 729.1?
Well, the answer here is no. Making assumptions does not support compliant coding. From a clinical standpoint, pain can be caused by various reasons. Even if the diagnosis seems obvious, coders are not clinicians and should never make presumptions.
If your radiologist did not specifically document myofascial pain or myalgia and you use one of those codes, you could land in trouble in case of a payer audit. Such mistakes are just the kind of thing that auditors watch out for. In its place, you may be required to report an unspecified code, such as 724.5.
Remember payers may not always accept 'unspecified' codes in assistance of a service; however some payers will reimburse for 724.5 for trigger point injections. As such, be sure to study your payer coverage policies well prior to determining if the diagnosis fits the payer's rules. As a coder, you should be aware of payer policies and LCDs to be able to convey that information to the physician.
Bear in mind that spot on medical coding requires that you select code based on the documentation you must never report a diagnosis code just because you are aware the payer will pay the service if you report that diagnosis.
