Anesthesia Coding Alert

READER QUESTIONS:

Distinguish 727.61 From 840.4 With Ease

Question: In treating pain stemming from an injury to the rotator cuff, how do you determine which code to use: 727.61 or 840.4? Nebraska Subscriber Answer: Miscoding either one of these scenarios is a fairly common mistake. Typically, 840.4 (Sprains and strains of shoulder and upper arm, rotator cuff [capsule]) should be used for an acute injury, while 727.61 (Complete rupture of rotator cuff) is used to report a chronic condition. The difference is traumatic versus nontraumatic. Sometimes you may find clues based on the patient's age and whether it was accident- or sportsrelated. You should look for supporting documentation to determine if the rotator cuff has suffered a traumatic (840.4) versus non-traumatic (727.61) tear, sprain, strain, or rupture. You'll see the non-traumatic diagnosis more frequently in older patients. If you can't find a definitive diagnosis in the documentation -- for example, if the documentation states "rotator cuff syndrome"-- use 726.10 [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more