Pain Management Coding Alert

Question: A new patient reported to the PM provider complaining of intense shin pain. After a level-two evaluation and management (E/M) service, the provider diagnosed “shin splints.” What is the correct ICD-10 code for shin splints?

Arkansas Subscriber

Answer: This one is a little difficult to track down if you don’t know where to look, because the ICD-10 codes do not spell out “shin splints.” If, however, you look under “Shin splints” in the ICD-10 index, you’ll be directed to S86.89- (Other injury of other muscles and tendons at lower leg level).

Once you arrive at this code set, you’ll choose one of the following codes for your 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making … ) claim, depending on encounter specifics:

• S86.891- — Other injury of other muscle(s) and tendon(s) at lower leg level, right leg
• S86.892- — … left leg
• S86.899- — … unspecified leg.

Don’t stop there: Each of the shin splint ICD-10 codes calls for a seventh character to indicate the type of encounter: initial (A), subsequent (D), or sequela (S). Go back and check the notes to be sure, but it sounds as if you would choose A for the seventh character on this patient’s shin splints, since the provider diagnosed them during the E/M.

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