Wiki 20610 DX Issue

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amber2262

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Local Chapter Officer
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Powell, TN
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I might be overthinking this, but I can't wrap my brain around it to save my life. Our guidelines are crystal clear that if we have a definitive diagnosis, we are NOT to code any symptoms that are considered to be associated with the definitive diagnosis.

My issue: Payers are denying the 20610 when we use anything other than a pain diagnosis.

Example: pt has right rotator cuff tear and provider decides to give them an injection to alleviate the pain

My thoughts: the rotator cuff tear is the correct dx, but it will not pass through the edits based on the dx being inappropriate for the procedure.

Can anyone please tell me how they are handling this?
 
You are over thinking this one.

But hey we all do and make embarrassing mistakes so no worries.

The shoulder injection is NOT TREATING the RTC tear. The injection does nothing for the tear.

The injection is treating the pain.

This is also performed due to impingement as well. It will stop the pain for a while but usually the patient will need surgery at some point.
 
Also use the G89 odes for the pain as these are technically not symptom codes but diagnosis codes for conditions involving the nervous system. Read the guidelines for pain management. You use the G89 code first followed by the reason for the pain such as rotator cuff tear or the M code for shoulder pain but not both of those.
 
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