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Orthopedic Coding Alert

Expert Strategies Help You Manage Your Rotator Cuff Upgrades With Confidence

Published on Sat Sep 05, 2009

Is your payer's advice lacking? Here's how to create internal guidelines for chronic/acute conditions. Upgrading a rotator cuff strain to a torn rotator cuff can land your claim in troubled waters, especially as local carrier direction can be nonexistent. If your insurance adjuster lacks specific chronic/acute advice, create your own internal guidelines -- our experts show you how. Scenario: Suppose a patient suffers a rotator cuff strain (840.4) while lifting boxes at work. The patient's workers' compensation carrier reimburses the practice for several months, after which the orthopedist decides that the patient requires surgery to repair what the physician determines is actually a torn rotator cuff (727.61). At this point, the workers' compensation insurer balks, stating that the claim will not be paid because it never authorized treatment for a torn rotator cuff. Can your practice upgrade a patient from an acute condition to a chronic one? Here's our experts' breakdown. [...]
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