Part B Insider (Multispecialty) Coding Alert
'Joint Fracture' Is a Misnomer
Question: Which diagnosis code should I use for an SI joint fracture? Answer:
When looking at these types of fractures, you should keep in mind that you can't have a sacroiliac (SI) joint fracture because you can't fracture a joint, only a bone. Consequently, this would be either a sacral fracture at the SI joint (806.6x, Fracture of vertebral column with spinal cord injury; sacrum and coccyx, closed; or 805.6, Fracture of vertebral column without mention of spinal cord injury; sacrum and coccyx, closed) or a fracture of the ilium (808.41, Fracture of pelvis; other specified part, closed; ilium).
Before you report this, however, you should check to make sure that this is a true fracture and not a stress fracture because this distinction can change your diagnosis coding. If this is a stress fracture, you'll report 733.95 (Stress fracture of other bone) as well as the sacral or ilium fracture code.
Part B Insider (Multispecialty) Coding Alert
- CPT 2011:
CPT 2011 to Debut Codes for Hip Arthroscopy, Subsequent Observation Care
Check out this sneak peek to get a glimpse of the codes you'll be using [...] - E/M Coding:
Knock Out Questions on New/Established Patient E/M
Remember, what used to be a consultation is now likely a CPT 99201 [...] - Part B Mythbuster:
Overcome Medically-Unlikely Edit Denial Challenges by Busting 4 Myths
If you ignore the medically unlikely edits, you're asking for a denial.If you're receiving denials [...] - Reader Questions:
Look for Causes Before Coding Sleep Apnea
Question: What ICD-9 code should I report when the physician performs a level-two E/M on [...] - Reader Questions:
Bilateral Done On 1 Side Means 52
Question: A patient underwent a hysteroscopy. The code 58565 represents a bilateral procedure, but in [...] - Reader Questions:
'Diagnostic' and 'Therapeutic' Defined
Question:Can you explain the difference between "diagnostic" and "therapeutic" injections or nerve blocks? How does [...] - Reader Questions:
Stick With Correct Code, Even if Non-covered
Question:Our payer included codes 64470-64476 on the 2009 physician fee schedule, but dropped them in [...] - Reader Questions:
'Joint Fracture' Is a Misnomer
Question: Which diagnosis code should I use for an SI joint fracture?Answer: When looking at [...] - Physician Notes:
CMS Offers Tool to Determine When Medicare is Secondary
Plus: OIG blasts suppliers' modifier KX claims.When a patient has no other insurance coverage besides [...]
