Orthopedic Coding Alert

Question: Our surgeon suspected that a patient had a torn meniscus and circled 836.0 on his evaluation superbill. Then the MRI results came back negative. So should we change the code on his superbill, or report the claim with 836.0?


North Dakota Subscriber

Answer: You should ask the surgeon to made an addendum to his original notes so he can clarify that 836.0 (Tear of medial cartilage or meniscus of knee, current) was merely a suspected diagnosis.

You should ask the surgeon to identify the reason that the patient came to the practice (such as knee pain or inability to walk) and use that as your diagnosis code for the E/M visit.

But you should not report ICD-9 code 836.0 as your diagnosis code if the MRI results came back negative for a meniscal tear.

CMS program memorandum AB-01-144, released in 2002, stated that if the physician confirms a diagnosis, he should report that diagnosis instead of the signs or symptoms that prompted the procedure.

The key word in that sentence is -if,- because if the orthopedist doesn-t confirm a diagnosis, you should instead report the signs and symptoms that prompted the visit.

You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.