Orthopedic Coding Alert

Question: A patient comes in with shoulder pain and possible separation. The orthopedist takes an x-ray of the patients other shoulder to compare the two. What diagnosis code should I use for the good shoulder?

Alabama Subscriber

Answer: For the good shoulder that the orthopedist used for comparison, you should use V72.5 (Radiological examination, not elsewhere classified) when the patient has no signs, symptoms or associated diagnoses.

Watch out: If you use this code on the claim, however, Medicare will treat it as a noncovered, nonmedically necessary service that the patient is financially responsible for. This can result in an unhappy patient who may take his complaints back to his treating physician.

For the other shoulder, you should use 719.41 (Pain in joint; shoulder region).