Wiki Ortho dx codes issues

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jessicamarquez05

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I'm new to working at an Ortho office. I have multiple Dr's that when they see the pt and suspect a meniscus tear or ACL tear they are coding those dx's without having an MRI first. My understanding is that we would have to code the signs and symptoms until verified by an MRI. In their notes they are stating "most consistent with" so i have been changing the dx to knee pain ect. One of the Dr's told me well how do we get auth for the MRI's without a dx of a tear, I explained we cannot use a dx if it's just suspected. I just want to make sure what I'm doing is correct. Any insight would be helpful.
 
I would argue orthopedic providers can diagnose a meniscus tear or ACL tear without imaging due to the physical exam and presentation of the patient.
I agree, if the words "consistent with" are used you shouldn't code it.
However, if they clearly state in the documentation (without words such as possible, probably, suspected, etc.) the patient has a medial meniscus tear, for example, I argue it can be coded without an MRI.
I would also point to the S diagnosis codes depending on the mechanism of injury and if it is a "new", "acute" problem or not. If it is chronic, that's a different story and would most likely be pain in knee, etc. It all comes down to the documentation.
My 2 cents.
 
amyjph said:
I would argue orthopedic providers can diagnose a meniscus tear or ACL tear without imaging due to the physical exam and presentation of the patient.
I agree, if the words "consistent with" are used you shouldn't code it.
However, if they clearly state in the documentation (without words such as possible, probably, suspected, etc.) the patient has a medial meniscus tear, for example, I argue it can be coded without an MRI.
I would also point to the S diagnosis codes depending on the mechanism of injury and if it is a "new", "acute" problem or not. If it is chronic, that's a different story and would most likely be pain in knee, etc. It all comes down to the documentation.
My 2 cents.
Click to expand...
Thank you! I appreciate your input. :)
 
I see that you have your
amyjph said:
I would argue orthopedic providers can diagnose a meniscus tear or ACL tear without imaging due to the physical exam and presentation of the patient.
I agree, if the words "consistent with" are used you shouldn't code it.
However, if they clearly state in the documentation (without words such as possible, probably, suspected, etc.) the patient has a medial meniscus tear, for example, I argue it can be coded without an MRI.
I would also point to the S diagnosis codes depending on the mechanism of injury and if it is a "new", "acute" problem or not. If it is chronic, that's a different story and would most likely be pain in knee, etc. It all comes down to the documentation.
My 2 cents.
Click to expand...
i see that you have your COSC, I'm thinking about taking the course. did you find it helpful?
 
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