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Anesthesia Coding Alert

READER QUESTIONS:

Damage Determines Biceps Tear Diagnosis

Published on Tue Apr 10, 2007

Question: What diagnosis should I report for a biceps tear? I haven't found it in ICD-9's index.

Maine Subscriber

 

      Answer: "Rupture" is a tearing or disruption of tissue. People often use the terms "rupture" and "tear" interchangeably, so look under "Rupture, tendon, biceps" in the ICD-9 index instead of "Tear." You'll find three options for a biceps tear: 840.8 (Sprains and strains of shoulder and upper arm; other specified sites of shoulder and upper arm), 840.9 (... unspecified site of shoulder and upper arm) and 727.62 (Rupture of tendon, nontraumatic; tendons of biceps [long head]). 

            When reporting this case, code according to the injury's extent. Sprains and strains are usually considered traumatic, but tears or ruptures do not have to be traumatic. Opt for 727.62 for a non-traumatic tear, and choose either 840.8 or 840.9 for a traumatic injury. Some coders say reporting 840.8 for a biceps tear is acceptable, but others lean toward 840.9 because the choices don't include a specific code for "biceps." Talk with your physician about which diagnosis is more accurate. 

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