# ICD 9 Coding and Integral Process



## jifnif (Apr 21, 2011)

I need an opinion on certain scenarios and on top of it, I really need the source of where to find it in writing.  If it is in the ICD 9 guidelines somewhere, please just let me know exactly where b/c I have been over and over and still can't find this subject in particular.  

Okay, pt comes in for knee injection due to pain in knee.  Pt has degenerative joint disease.  What would you code?  719.46 or 715.36 or both?

Same situation; pt comes in for injection and has low back pain with spondylosis.  Do you code 724.2 and 721.3 or only 721.3?

Thank you for any help!

I know about signs and symptoms but I need to know in writing if you code for what is being treated and not the disease process.


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## TonyaMichelle (Apr 21, 2011)

If the doctor gave the final diagnosis degenerative joint disease in the knee, I would code 715.96 alone because knee pain is actually the chief complaint 719.46. I don't think that I would use 715.36 unless the doctor specified that the degeneration was localized.

For the second question, if the doctor's diagnosis is "low back pain with spondylosis", I would code 724.2 as the primary and 721.3 as the secondary because category code 724 excludes spondylosis. Hope this helps.


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## jifnif (Apr 21, 2011)

Great explanations, Thank you!  

So let me get more detailed and say that the pt has a history of DJD listed under PMH and pt comes in for injection.  CC is pain.  How would you go?  I am thinking it is all a matter of how it is stated but need to be positive.


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## TonyaMichelle (Apr 24, 2011)

CC: Pain 
PMH: DJD

Treatment: Injection

I would code DJD as the primary diagnosis 715.90 ,  because looking at past medical history as DJD, and knowing the disease process of DJD as non-curable but treatable, it is not resolved and that would be the cause of the patient's chief complaint. Also the DJD was not specified as localized or generalized and no site mentioned. The second diagnosis I would use is V58.65 ( long term use of Steroids) for the injection if that is the medication the doctor is administering for the pain and/or inflammation. The reason I chose V58.65 is because the coding guideline states," Assign a code from subcategory V58.6, Long term (current) drug use, if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis)......etc.  Hope this helps.


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## mitchellde (Apr 24, 2011)

In the coding guidelines it has a section devote to pain coding.  The 338.xx codes are to be used for pain control and pain management encounters.  It discusses how you are allowed to code the symptom of pain along with the definitive condition say DJD when the purpose of the encounter is to treat the pain and not the disease.  It also discusses the documentation and that the provider must state acute or chronic pain to use a 338.xx code.  If the drug is being given to relieve pain and not treat the disease then I would use a pain code first per the guidelines.  If the documentation does not specify acute or chronic then following the pain guidelines and the fact that the treatment is directed to the pain I would use the 719.xx code for the pain as the drug is not being used a threapeutic measure for the DJD.  I suggest reading the pain guidelines first.


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## TonyaMichelle (Apr 24, 2011)

Why would you code the symptom when you have the diagnosis that is causing the symptom which is pain?  The Past Med Hx is DJD in which pain and inflammation is part of the disease process. Since DJD has no cure, it will not be resolved, but it can be treated with pain management, ROM exercise and/or surgery if necessary. So, I would think that unless this patient comes in with pain unrelated to DJD, (for eg. abdominal pain), I would code the DJD for the related symptoms the patient presents with during the visit.


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## mitchellde (Apr 24, 2011)

TonyaMichelle said:


> Why would you code the symptom when you have the diagnosis that is causing the symptom which is pain?  The Past Med Hx is DJD in which pain and inflammation is part of the disease process. Since DJD has no cure, it will not be resolved, but it can be treated with pain management, ROM exercise and/or surgery if necessary. So, I would think that unless this patient comes in with pain unrelated to DJD, (for eg. abdominal pain), I would code the DJD for the related symptoms the patient presents with during the visit.



As I indicated, following the pain guidelines ,I would code pain (338.xx) plus the DJD dx if the encounter is for pain management/pain control.  As you indicated the visit is not for treatment of the DJD it is for the treatment of the pain.  DJD cannot be treated with pain management, pain can be treated with pain management.  Please read the section on pain in the guidelines, this is one exception to the rule that says do not code the symptoms with the definitive.


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## TonyaMichelle (Apr 25, 2011)

Ok, thanks.


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## TonyaMichelle (Apr 25, 2011)

I read the guideline and it also says that the underlying cause of pain should be used as an additional diagnosis.


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## mitchellde (Apr 25, 2011)

Yes that is what I indicated code the pain and the DJD.


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## TonyaMichelle (Apr 25, 2011)

I wholeheartedly agree, Thanks.


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